Healthcare Provider Details

I. General information

NPI: 1932139730
Provider Name (Legal Business Name): PRESTIGE HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOUISIANA BLVD NE SUITE A-2
ALBUQUERQUE NM
87110-3532
US

IV. Provider business mailing address

2900 LOUISIANA BLVD NE SUITE A-2
ALBUQUERQUE NM
87110-3532
US

V. Phone/Fax

Practice location:
  • Phone: 505-880-0400
  • Fax: 505-880-0404
Mailing address:
  • Phone: 505-880-0400
  • Fax: 505-880-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3235
License Number StateNM

VIII. Authorized Official

Name: MRS. ROSELYN K DUFOUR
Title or Position: CEO
Credential: RN, BSN
Phone: 505-880-0400