=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740144716
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTIGE PROPERTY AND CONSTRUCTION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2025
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 PREAKNESS LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29045-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-972-4397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 PREAKNESS LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29045-7129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-972-4397
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TOM LOUIS COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-972-4397
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------