Healthcare Provider Details

I. General information

NPI: 1588232110
Provider Name (Legal Business Name): PRESTIGE IN HOME CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180B DENHAM WINCHESTER RD
WAYNESBORO MS
39367-8738
US

IV. Provider business mailing address

PO BOX 1526
WAYNESBORO MS
39367-1526
US

V. Phone/Fax

Practice location:
  • Phone: 601-381-2515
  • Fax:
Mailing address:
  • Phone: 601-381-2515
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: KAREN R TROTTER
Title or Position: OWNER
Credential:
Phone: 601-381-2515