Provider Demographics
NPI:1053665935
Name:PRESTIGE HEALTHCARE RESOURCES INC.
Entity Type:Organization
Organization Name:PRESTIGE HEALTHCARE RESOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SAYE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:240-644-3578
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:SUITE 3B1
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:240-644-3578
Mailing Address - Fax:202-204-5758
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:SUITE 3B1
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:240-644-3578
Practice Address - Fax:202-204-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8005000Medicaid