Healthcare Provider Details

I. General information

NPI: 1457112567
Provider Name (Legal Business Name): PRESTIGE HEALTHCARE RESOURCES BH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HIOAKS RD
RICHMOND VA
23225-4043
US

IV. Provider business mailing address

681 HIOAKS RD STE G
RICHMOND VA
23225-4043
US

V. Phone/Fax

Practice location:
  • Phone: 703-712-3066
  • Fax:
Mailing address:
  • Phone: 703-712-3066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NICHOLA MCCARGO
Title or Position: DIRECTOR
Credential:
Phone: 703-712-3066