Provider Demographics
NPI:1790452506
Name:PRESTIGE HEALTH RESOURCES
Entity Type:Organization
Organization Name:PRESTIGE HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDAE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:682-400-4006
Mailing Address - Street 1:2140 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4847
Mailing Address - Country:US
Mailing Address - Phone:682-400-4006
Mailing Address - Fax:682-400-4007
Practice Address - Street 1:2140 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4847
Practice Address - Country:US
Practice Address - Phone:682-400-4006
Practice Address - Fax:682-400-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty