Healthcare Provider Details

I. General information

NPI: 1790628006
Provider Name (Legal Business Name): PRESTIGE FAMILY CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 WASHINGTON AVE STE 519
SAINT LOUIS MO
63103-1901
US

IV. Provider business mailing address

1409 WASHINGTON AVE STE 519
SAINT LOUIS MO
63103-1901
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-9302
  • Fax:
Mailing address:
  • Phone: 314-226-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NAKYA MARNELL BROWN
Title or Position: OWNER
Credential:
Phone: 314-225-9357