Healthcare Provider Details

I. General information

NPI: 1457275455
Provider Name (Legal Business Name): PRESTIGE HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W GRAND RIVER AVE STE A
OKEMOS MI
48864-1604
US

IV. Provider business mailing address

1621 CENTRAL AVE
CHEYENNE WY
82001-4531
US

V. Phone/Fax

Practice location:
  • Phone: 616-207-7707
  • Fax:
Mailing address:
  • Phone: 616-207-7707
  • 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: CHRISTOPHER DUNCAN
Title or Position: MANAGER
Credential:
Phone: 616-207-7707