Healthcare Provider Details

I. General information

NPI: 1518455906
Provider Name (Legal Business Name): PRESTIGE QUALITY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 E 116TH ST
NEW YORK NY
10029-1075
US

IV. Provider business mailing address

798 WESTCHESTER AVE
BRONX NY
10455-1735
US

V. Phone/Fax

Practice location:
  • Phone: 718-552-2895
  • Fax:
Mailing address:
  • Phone: 718-552-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MANUEL VIDAL
Title or Position: CEO
Credential:
Phone: 917-494-4035