Provider Demographics
NPI:1851090005
Name:PRESTIGE IN-HOME SERVICES LLC
Entity Type:Organization
Organization Name:PRESTIGE IN-HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:NKANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-839-0438
Mailing Address - Street 1:3903 FORESTDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2227
Mailing Address - Country:US
Mailing Address - Phone:703-839-0438
Mailing Address - Fax:
Practice Address - Street 1:3903 FORESTDALE AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2227
Practice Address - Country:US
Practice Address - Phone:703-839-0438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health