Provider Demographics
NPI:1821657933
Name:PRESTIGIOUS HOME CARE, LLC
Entity Type:Organization
Organization Name:PRESTIGIOUS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-404-1755
Mailing Address - Street 1:190 PIN OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194
Mailing Address - Country:US
Mailing Address - Phone:662-404-1755
Mailing Address - Fax:
Practice Address - Street 1:190 PIN OAK DRIVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194
Practice Address - Country:US
Practice Address - Phone:662-404-1755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care