Healthcare Provider Details

I. General information

NPI: 1265298392
Provider Name (Legal Business Name): PRESTIGE SENIOR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19068 PINE LEDGE DR
BROWNSTOWN MI
48193-7494
US

IV. Provider business mailing address

19068 PINE LEDGE DR
BROWNSTOWN MI
48193-7494
US

V. Phone/Fax

Practice location:
  • Phone: 734-286-4878
  • Fax:
Mailing address:
  • Phone: 734-286-4878
  • 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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MA ISABEL ESQUIBLE
Title or Position: DIRECTOR
Credential: CARE GIVER
Phone: 734-286-4878