Provider Demographics
NPI:1336413640
Name:PRESTIGE COMPANIONS HOME CARE OF NC AGENCY
Entity type:Organization
Organization Name:PRESTIGE COMPANIONS HOME CARE OF NC AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNESSA
Authorized Official - Middle Name:LAMEKA
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-519-1602
Mailing Address - Street 1:PO BOX 15940
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-0940
Mailing Address - Country:US
Mailing Address - Phone:919-490-0200
Mailing Address - Fax:919-490-0221
Practice Address - Street 1:3329 CHAPEL-HILL BLVD. SERVICE RD
Practice Address - Street 2:STE. 200-D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-490-0200
Practice Address - Fax:919-490-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4520251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health