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General NPI Number Information
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NPI Number | 1215703780
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Entity Type | Organization
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Legal Business Name | PRESTIGE SUPPORT SERVICES
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 44 COOPER ST STE 1
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City | WOODBURY
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State | NJ
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Zip | 08096-4639
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Country | US
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Telephone | 856-579-4245
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Fax | 856-997-9098
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Provider Business Mailing Address
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Address Line | 44 COOPER ST STE 1
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City | WOODBURY
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State | NJ
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Zip | 08096-4639
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Country | US
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Telephone | 856-579-4245
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Fax | 856-997-9098
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VAN A DAUTRUCHE
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Credential |
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Telephone | 856-535-0429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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