Healthcare Provider Details

I. General information

NPI: 1083183065
Provider Name (Legal Business Name): PRESTONWOOD ENCORE ADEC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 W PARK BLVD STE 116
PLANO TX
75093-6210
US

IV. Provider business mailing address

6505 W PARK BLVD STE 116
PLANO TX
75093-6210
US

V. Phone/Fax

Practice location:
  • Phone: 972-428-5400
  • Fax: 972-428-5401
Mailing address:
  • Phone: 972-428-5400
  • Fax: 972-428-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER LESTER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 972-428-5400