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NPI Code Detail

MEDICARE: PRESTIGE HEALTHCARE RESOURCES INC.

MEDICARE: PRESTIGE HEALTHCARE RESOURCES INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1326615089
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESTIGE HEALTHCARE RESOURCES INC.
Provider Business Mailing Address
First Line : 6011 EMERSON ST APT 209
Second Line :
City : BLADENSBURG
State : MD
Zip : 20710-1829
Country : US
Telephone Number : 240-644-3578
Fax Number :
Provider Business Practice Location Address
First Line : 9500 MEDICAL CENTER DR STE 104
Second Line :
City : LARGO
State : MD
Zip : 20774-3703
Country : US
Telephone Number : 240-644-3578
Fax Number :
Authorized Official
Title or Position : CEO
Name : JOHN SAYE SMITH JR.
Credential : BSN
Telephone Number : 240-644-3578
Provider Enumeration Date : 06/09/2021
Last Update Date : 02/20/2022

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