Provider Demographics
NPI:1144795154
Name:PRESTIGE ADULT DAY CARE LLC
Entity Type:Organization
Organization Name:PRESTIGE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASSANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAKHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-277-5910
Mailing Address - Street 1:2860 S. HAVANA ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 S HAVANA ST
Practice Address - Street 2:UNIT C
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:720-277-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care