Healthcare Provider Details

I. General information

NPI: 1518668573
Provider Name (Legal Business Name): THE PRESTIGE CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 TANYARD CREEK DR
THOMSON GA
30824-7022
US

IV. Provider business mailing address

246 ROBERT C DANIEL JR PKWY # 1402
AUGUSTA GA
30909-0803
US

V. Phone/Fax

Practice location:
  • Phone: 706-361-3704
  • Fax:
Mailing address:
  • Phone: 706-361-3704
  • 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 Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VALENA DENISE BRINKLEY
Title or Position: OWNER
Credential:
Phone: 706-361-3704