Organization
PRESTIGE SUPPORT SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENYA ALA (OWNER)
(912) 432-5254
Entity
Organization
Contact information
Practice address
1317 WOOD LAKE CIR, SAINT CLOUD, FL 34772-7467
(407) 593-2621
Mailing address
1317 WOOD LAKE CIR, SAINT CLOUD, FL 34772-7467
(407) 556-3992
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108873400
—
FL
01
—
237380
AHCA - HOMEMAKER COMPANION
FL
Enumeration date
08/03/2021
Last updated
06/21/2022
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