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General NPI Number Information
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NPI Number | 1871090803
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Entity Type | Organization
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Legal Business Name | PRESTIGE CARE CENTER
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 474 SUNDAY DR
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City | TURLOCK
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State | CA
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Zip | 95382-9625
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Country | US
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Telephone | 209-534-3245
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Fax |
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Provider Business Mailing Address
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Address Line | 474 SUNDAY DR
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City | TURLOCK
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State | CA
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Zip | 95382-9625
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Country | US
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Telephone | 209-534-3245
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | TANISHA MCNEAL
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Credential |
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Telephone | 209-534-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 502700165
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License Number State | CA
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