Healthcare Provider Details

I. General information

NPI: 1124957832
Provider Name (Legal Business Name): PRESTIGE CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42723 GEORGETOWN
NOVI MI
48375-1765
US

IV. Provider business mailing address

42723 GEORGETOWN
NOVI MI
48375-1765
US

V. Phone/Fax

Practice location:
  • Phone: 313-693-3315
  • Fax:
Mailing address:
  • Phone: 313-693-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAKYRA SANDERS
Title or Position: OWNER
Credential: LPN
Phone: 313-693-3315