Provider Demographics
NPI:1699183350
Name:PRISM HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PRISM HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:PRACHI
Authorized Official - Middle Name:B
Authorized Official - Last Name:RATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, OTR/L, LMT, CAP
Authorized Official - Phone:904-880-9900
Mailing Address - Street 1:6971 BUSINESS PARK BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2777
Mailing Address - Country:US
Mailing Address - Phone:904-880-9900
Mailing Address - Fax:904-880-3241
Practice Address - Street 1:6971 BUSINESS PARK BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2777
Practice Address - Country:US
Practice Address - Phone:904-880-9900
Practice Address - Fax:904-880-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313910332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies