Provider Demographics
NPI:1619577475
Name:PRESTIGE BEHAVIORAL HEALTH CENTER CORP
Entity Type:Organization
Organization Name:PRESTIGE BEHAVIORAL HEALTH CENTER CORP
Other - Org Name:PRESTIGE BEHAVIORAL HEALTH CENTER CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-340-5318
Mailing Address - Street 1:7318 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1855
Mailing Address - Country:US
Mailing Address - Phone:786-762-2041
Mailing Address - Fax:
Practice Address - Street 1:7318 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1855
Practice Address - Country:US
Practice Address - Phone:786-762-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health