Provider Demographics
NPI:1710125315
Name:PRESTIGE PARKSIDE CENTER
Entity Type:Organization
Organization Name:PRESTIGE PARKSIDE CENTER
Other - Org Name:HAPPY HEARTS DAY TREATMENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSAERENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-589-5483
Mailing Address - Street 1:11220 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2014
Mailing Address - Country:US
Mailing Address - Phone:856-589-5483
Mailing Address - Fax:856-210-1482
Practice Address - Street 1:11220 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2014
Practice Address - Country:US
Practice Address - Phone:856-589-5483
Practice Address - Fax:856-210-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health