Provider Demographics
NPI:1588232110
Name:PRESTIGE IN HOME CARE AGENCY, LLC
Entity type:Organization
Organization Name:PRESTIGE IN HOME CARE AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-381-2515
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-1526
Mailing Address - Country:US
Mailing Address - Phone:601-381-2515
Mailing Address - Fax:
Practice Address - Street 1:180B DENHAM WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-8738
Practice Address - Country:US
Practice Address - Phone:601-381-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No342000000XTransportation ServicesTransportation Network Company