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General NPI Number Information
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NPI Number | 1528432408
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Entity Type | Organization
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Legal Business Name | PRESTIGE HOME HEALTH CARE
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 4000 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-6879
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Country | US
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Telephone | 704-965-8413
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 WAKE FOREST RD
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City | RALEIGH
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State | NC
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Zip | 27609-6879
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Country | US
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Telephone | 704-965-8413
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CANDACE STEVENSON
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Credential | CERTIFIED NA
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Telephone | 704-965-8413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC3621
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC3621
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License Number State | NC
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