Healthcare Provider Details

I. General information

NPI: 1053665935
Provider Name (Legal Business Name): PRESTIGE HEALTHCARE RESOURCES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CONSTITUTION LN SUITE 3B1
DANVERS MA
01923-3694
US

IV. Provider business mailing address

85 CONSTITUTION LN SUITE 3B1
DANVERS MA
01923-3694
US

V. Phone/Fax

Practice location:
  • Phone: 240-644-3578
  • Fax: 202-204-5758
Mailing address:
  • Phone: 240-644-3578
  • Fax: 202-204-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN SAYE SMITH JR.
Title or Position: CLINICAL DIRECTOR
Credential: REGISTERED NURSE
Phone: 240-644-3578