MEDICARE: PRESTIGE RESIDENTIAL SERVICES

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
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1841155264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE RESIDENTIAL SERVICES

Provider Business Mailing Address
First Line	:	460 IRVINE TURNER BLVD
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-2680
Country	:	US
Telephone Number	:	347-489-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 IRVINE TURNER BLVD
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07108-2680
Country	:	US
Telephone Number	:	347-489-8551
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. NIGEL JAMES
Credential	:
Telephone Number	:	347-489-8551

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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