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General NPI Number Information
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NPI Number | 1144516824
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Entity Type | Organization
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Legal Business Name | PRESTIGE HEALTHCARE RESOURCES INC.
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 02/20/2022
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Provider Practice Location Address
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Address Line | 6011 EMERSON ST SUITE 209
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City | BLADENSBURG
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State | MD
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Zip | 20710
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Country | US
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Telephone | 240-644-3578
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Fax | 202-204-5758
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Provider Business Mailing Address
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Address Line | 6011 EMERSON ST APT 209
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City | BLADENSBURG
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State | MD
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Zip | 20710-1829
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Country | US
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Telephone | 240-644-3578
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Fax | 202-204-5758
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN SAYE SMITH JR.
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Credential | RN
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Telephone | 240-644-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R3017P
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | DC
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