Provider Demographics
NPI:1518668573
Name:THE PRESTIGE CARE HOME LLC
Entity type:Organization
Organization Name:THE PRESTIGE CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALENA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-361-3704
Mailing Address - Street 1:246 ROBERT C DANIEL JR PKWY # 1402
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0803
Mailing Address - Country:US
Mailing Address - Phone:706-361-3704
Mailing Address - Fax:
Practice Address - Street 1:1341 TANYARD CREEK DR
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7022
Practice Address - Country:US
Practice Address - Phone:706-361-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty