Provider Demographics
NPI:1912578261
Name:PRESTIGE ABA SERVICES LLC
Entity Type:Organization
Organization Name:PRESTIGE ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIRELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:RBT-20-124181
Authorized Official - Phone:786-317-0100
Mailing Address - Street 1:714 MCARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-1214
Mailing Address - Country:US
Mailing Address - Phone:786-317-0100
Mailing Address - Fax:786-490-2838
Practice Address - Street 1:2100 W 76TH ST STE 211
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5503
Practice Address - Country:US
Practice Address - Phone:786-317-0100
Practice Address - Fax:786-490-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health