Healthcare Provider Details

I. General information

NPI: 1992345599
Provider Name (Legal Business Name): PRESTIGE PERSONAL CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAIN ST # 536
COLUMBIA SC
29201-5801
US

IV. Provider business mailing address

PO BOX 90601
COLUMBIA SC
29290-1601
US

V. Phone/Fax

Practice location:
  • Phone: 803-828-3022
  • Fax: 833-422-0158
Mailing address:
  • Phone: 803-828-3022
  • Fax: 833-422-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LASHANDA WILSON
Title or Position: OWNER
Credential:
Phone: 803-828-3022