Healthcare Provider Details

I. General information

NPI: 1326615089
Provider Name (Legal Business Name): PRESTIGE HEALTHCARE RESOURCES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 02/20/2022
Certification Date: 02/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MEDICAL CENTER DR STE 104
LARGO MD
20774-3703
US

IV. Provider business mailing address

6011 EMERSON ST APT 209
BLADENSBURG MD
20710-1829
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN SAYE SMITH JR.
Title or Position: CEO
Credential: BSN
Phone: 240-644-3578