Provider Demographics
NPI:1588118467
Name:PRESTIGIOUS HOMES OF NC INC
Entity type:Organization
Organization Name:PRESTIGIOUS HOMES OF NC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-521-9342
Mailing Address - Street 1:PO BOX 6274
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-6274
Mailing Address - Country:US
Mailing Address - Phone:252-521-9340
Mailing Address - Fax:252-343-7469
Practice Address - Street 1:107 SE MAIN ST
Practice Address - Street 2:STE 216
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5400
Practice Address - Country:US
Practice Address - Phone:252-521-9340
Practice Address - Fax:252-343-7469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGIOUS HOMES OF NC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-09
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4798253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4798OtherNORTH CAROLINA HOME CARE LICENSE