Provider Demographics
NPI:1982378006
Name:PRESTIGE SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:PRESTIGE SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-432-5254
Mailing Address - Street 1:1317 WOOD LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-7467
Mailing Address - Country:US
Mailing Address - Phone:407-556-3992
Mailing Address - Fax:
Practice Address - Street 1:1317 WOOD LAKE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-7467
Practice Address - Country:US
Practice Address - Phone:407-593-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237380OtherAHCA - HOMEMAKER COMPANION
FL108873400Medicaid