Healthcare Provider Details

I. General information

NPI: 1487831194
Provider Name (Legal Business Name): PRESTIGE HOME SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 E MCIVER RD
FLORENCE SC
29501-9640
US

IV. Provider business mailing address

1922 E MCIVER RD
FLORENCE SC
29501-9640
US

V. Phone/Fax

Practice location:
  • Phone: 843-669-4664
  • Fax: 843-669-9229
Mailing address:
  • Phone: 843-669-4664
  • Fax: 843-669-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALMEDA MYERS GRAHAM
Title or Position: OWNER
Credential: R.N. B.S.N.
Phone: 843-669-4664