Healthcare Provider Details

I. General information

NPI: 1457926305
Provider Name (Legal Business Name): PRESTIGE BEHAVIORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PONDELLA RD
NORTH FORT MYERS FL
33903-3846
US

IV. Provider business mailing address

150 PONDELLA RD
NORTH FORT MYERS FL
33903-3846
US

V. Phone/Fax

Practice location:
  • Phone: 239-789-0041
  • Fax: 321-413-3808
Mailing address:
  • Phone: 239-789-0041
  • Fax: 321-413-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARIANNA DANTA
Title or Position: CEO
Credential:
Phone: 239-789-0041