Healthcare Provider Details

I. General information

NPI: 1497301170
Provider Name (Legal Business Name): PRESTIGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 08/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 INDIAN TRAIL LILBURN RD STE 420
NORCROSS GA
30093-2644
US

IV. Provider business mailing address

2860 SUMMIT VALLEY DR
DACULA GA
30019-4008
US

V. Phone/Fax

Practice location:
  • Phone: 404-475-2600
  • Fax:
Mailing address:
  • Phone: 678-571-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE CLERIZIER
Title or Position: CEO/RN
Credential: RN
Phone: 678-571-2528