Healthcare Provider Details

I. General information

NPI: 1609643238
Provider Name (Legal Business Name): PRESTIGE ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 WILLARD AVE
LEHIGH ACRES FL
33972-7930
US

IV. Provider business mailing address

621 WILLARD AVE
LEHIGH ACRES FL
33972-7930
US

V. Phone/Fax

Practice location:
  • Phone: 786-317-0100
  • Fax: 813-776-1620
Mailing address:
  • Phone: 786-317-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAIRELYS CONCEPCION
Title or Position: OWNER
Credential:
Phone: 786-317-0100