Healthcare Provider Details

I. General information

NPI: 1093507295
Provider Name (Legal Business Name): PRESTIGE HOME WELLNESS SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 E 30TH ST
CHATTANOOGA TN
37407-1305
US

IV. Provider business mailing address

1323 E 30TH ST
CHATTANOOGA TN
37407-1305
US

V. Phone/Fax

Practice location:
  • Phone: 423-703-0544
  • Fax:
Mailing address:
  • Phone: 423-313-3081
  • Fax:

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: XIYYA QUINN JACKSON
Title or Position: CEO
Credential:
Phone: 423-313-3081