Provider Demographics
NPI:1225547342
Name:PRESTIGE WORLDWIDE, LLC
Entity Type:Organization
Organization Name:PRESTIGE WORLDWIDE, LLC
Other - Org Name:CENLA BEHAVIORAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JEFFREY CHARLES
Authorized Official - Last Name:RODGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-704-6008
Mailing Address - Street 1:5505 JOHN ESKEW DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3725
Mailing Address - Country:US
Mailing Address - Phone:318-704-6008
Mailing Address - Fax:
Practice Address - Street 1:5505 JOHN ESKEW DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3725
Practice Address - Country:US
Practice Address - Phone:318-704-6008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2054362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1927597Medicaid