Healthcare Provider Details

I. General information

NPI: 1912413840
Provider Name (Legal Business Name): PRESTIGE CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 HARVARD AVE
SAINT LOUIS MO
63130-3134
US

IV. Provider business mailing address

1515 N WARSON RD STE 122
SAINT LOUIS MO
63132-1108
US

V. Phone/Fax

Practice location:
  • Phone: 314-761-8002
  • Fax:
Mailing address:
  • Phone:
  • 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: SHANELL WHITE
Title or Position: OWNER
Credential:
Phone: 314-761-8002