Provider Demographics
NPI:1124589528
Name:PRESTIGE SENIOR ENRICHMENT CENTER INC
Entity Type:Organization
Organization Name:PRESTIGE SENIOR ENRICHMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-340-4734
Mailing Address - Street 1:2104 NORTHBAY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-8701
Mailing Address - Country:US
Mailing Address - Phone:336-912-8462
Mailing Address - Fax:336-763-8405
Practice Address - Street 1:2104 NORTHBAY DR
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-8701
Practice Address - Country:US
Practice Address - Phone:336-912-8462
Practice Address - Fax:336-763-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children