MEDICARE: PRESTIGE BEHAVIORAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261Q00000X	Clinic/Center
3	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457926305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE BEHAVIORAL CENTER LLC

Provider Business Mailing Address
First Line	:	150 PONDELLA RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3846
Country	:	US
Telephone Number	:	239-789-0041
Fax Number	:	321-413-3808

Provider Business Practice Location Address
First Line	:	150 PONDELLA RD
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-3846
Country	:	US
Telephone Number	:	239-789-0041
Fax Number	:	321-413-3808

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ARIANNA DANTA
Credential	:
Telephone Number	:	239-789-0041

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	03/03/2026

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