Healthcare Provider Details

I. General information

NPI: 1427632397
Provider Name (Legal Business Name): PRESTIGE QUALITY CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 TIMUQUANA RD #1
JACKSONVILLE FL
32210
US

IV. Provider business mailing address

6962 DEER ISLAND RD
JACKSONVILLE FL
32244-4577
US

V. Phone/Fax

Practice location:
  • Phone: 904-234-1059
  • Fax:
Mailing address:
  • Phone: 904-234-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JANICE V WILLIAMS
Title or Position: OWNER/ OPERATOR
Credential:
Phone: 904-234-1059