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NPI Code Detail

MEDICARE: PRESTIGE ARTISTIC THERAPY GROUP INC

MEDICARE: PRESTIGE ARTISTIC THERAPY GROUP INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1790322295
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESTIGE ARTISTIC THERAPY GROUP INC
Provider Business Mailing Address
First Line : 2167 15 MILE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-4820
Country : US
Telephone Number : 248-470-5644
Fax Number : 866-496-9908
Provider Business Practice Location Address
First Line : 2132 CENTRAL FLORIDA PKWY
Second Line :
City : ORLANDO
State : FL
Zip : 32837-8978
Country : US
Telephone Number : 248-470-5644
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. DIANE D KING
Credential :
Telephone Number : 248-470-5644
Provider Enumeration Date : 12/03/2019
Last Update Date : 12/03/2019

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