Provider Demographics
NPI:1144261041
Name:PRESTIGIOUS CARE
Entity type:Organization
Organization Name:PRESTIGIOUS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-635-6725
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:92 WHEAT ROAD
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0155
Mailing Address - Country:US
Mailing Address - Phone:803-635-6725
Mailing Address - Fax:803-635-6729
Practice Address - Street 1:92 WHEAT RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7003
Practice Address - Country:US
Practice Address - Phone:803-635-6725
Practice Address - Fax:803-635-6729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility