Healthcare Provider Details

I. General information

NPI: 1184017980
Provider Name (Legal Business Name): PRESTIGE ADULT FOSTER CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 LINCOLN ST
WORCESTER MA
01605-2106
US

IV. Provider business mailing address

286 LINCOLN ST
WORCESTER MA
01605-2106
US

V. Phone/Fax

Practice location:
  • Phone: 978-407-9339
  • Fax:
Mailing address:
  • Phone: 508-205-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMA

VIII. Authorized Official

Name: HIGHNESS GODWIN KAGUO
Title or Position: CEO
Credential:
Phone: 978-407-9339