Provider Demographics
NPI:1154340313
Name:PRESTIGE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:PRESTIGE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-759-8333
Mailing Address - Street 1:PO BOX 4736
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-0030
Mailing Address - Country:US
Mailing Address - Phone:813-759-8333
Mailing Address - Fax:813-759-8337
Practice Address - Street 1:102 SOUTHERN OAKS DR
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-1446
Practice Address - Country:US
Practice Address - Phone:813-759-8333
Practice Address - Fax:813-759-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health