Provider Demographics
NPI:1558535476
Name:PRESTIGE ADHC INC
Entity Type:Organization
Organization Name:PRESTIGE ADHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELSO
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-476-8774
Mailing Address - Street 1:1765 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6764
Mailing Address - Country:US
Mailing Address - Phone:408-586-9000
Mailing Address - Fax:408-516-8304
Practice Address - Street 1:1765 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6764
Practice Address - Country:US
Practice Address - Phone:408-586-9000
Practice Address - Fax:408-516-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care