Provider Demographics
NPI:1689150799
Name:PRESTIGE ADULT CENTER
Entity Type:Organization
Organization Name:PRESTIGE ADULT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ORLETTE
Authorized Official - Middle Name:SHEREE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-923-2262
Mailing Address - Street 1:366 N BROADWAY STE 410
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2000
Mailing Address - Country:US
Mailing Address - Phone:631-923-2262
Mailing Address - Fax:888-214-4343
Practice Address - Street 1:21 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3685
Practice Address - Country:US
Practice Address - Phone:631-923-2262
Practice Address - Fax:888-214-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care