Healthcare Provider Details

I. General information

NPI: 1871161042
Provider Name (Legal Business Name): MARLBORO PRESTIGE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BROAD ST STE F
BENNETTSVILLE SC
29512-4072
US

IV. Provider business mailing address

603 BROAD ST STE F
BENNETTSVILLE SC
29512-4072
US

V. Phone/Fax

Practice location:
  • Phone: 843-535-9611
  • Fax:
Mailing address:
  • Phone: 843-535-9611
  • 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

VIII. Authorized Official

Name: SHAVON STANTON
Title or Position: OWNER/MEMBER
Credential:
Phone: 843-535-9611