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General NPI Number Information
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NPI Number | 1164642914
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Entity Type | Organization
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Legal Business Name | PRESTIGE PROVIDER SERVICES INC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5219 S MCCOLL RD STE A
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City | EDINBURG
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State | TX
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Zip | 78539-4806
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Country | US
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Telephone | 956-664-9444
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Fax | 956-631-0580
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Provider Business Mailing Address
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Address Line | 5219 S MCCOLL RD STE A
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City | EDINBURG
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State | TX
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Zip | 78539-4806
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Country | US
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Telephone | 956-664-9444
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Fax | 956-631-0580
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAN VELAZQUEZ
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Credential |
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Telephone | 956-664-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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