Provider Demographics
NPI:1063042117
Name:PRESTIGE DETOX
Entity Type:Organization
Organization Name:PRESTIGE DETOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-935-3885
Mailing Address - Street 1:250 THELMA AVE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8091
Mailing Address - Country:US
Mailing Address - Phone:561-935-3885
Mailing Address - Fax:561-203-2689
Practice Address - Street 1:250 THELMA AVE
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8091
Practice Address - Country:US
Practice Address - Phone:561-935-3885
Practice Address - Fax:561-203-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility