Healthcare Provider Details

I. General information

NPI: 1134051675
Provider Name (Legal Business Name): PRESTIGIOUS HOMECARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 BOULDER VIEW PKWY
DALLAS GA
30157-2377
US

IV. Provider business mailing address

661 BOULDER VIEW PKWY
DALLAS GA
30157-2377
US

V. Phone/Fax

Practice location:
  • Phone: 772-216-0676
  • Fax:
Mailing address:
  • Phone: 772-216-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA STEEL
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 772-216-0676