Provider Demographics
NPI:1144688284
Name:PRESTIGE HOME CARE AGENCY
Entity type:Organization
Organization Name:PRESTIGE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-436-3494
Mailing Address - Street 1:1810 WINDING CROSSING TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1275
Mailing Address - Country:US
Mailing Address - Phone:678-436-3494
Mailing Address - Fax:678-436-3472
Practice Address - Street 1:1810 WINDING CROSSING TRL
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1275
Practice Address - Country:US
Practice Address - Phone:678-436-3494
Practice Address - Fax:678-436-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1530251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health