Provider Demographics
NPI:1184017980
Name:PRESTIGE ADULT FOSTER CARE LLC.
Entity Type:Organization
Organization Name:PRESTIGE ADULT FOSTER CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HIGHNESS
Authorized Official - Middle Name:GODWIN
Authorized Official - Last Name:KAGUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-407-9339
Mailing Address - Street 1:340 MAIN ST STE 975
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1601
Mailing Address - Country:US
Mailing Address - Phone:978-407-9339
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST STE 975
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1601
Practice Address - Country:US
Practice Address - Phone:978-407-9339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency