Provider Demographics
NPI:1932139730
Name:PRESTIGE HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:PRESTIGE HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:505-880-0400
Mailing Address - Street 1:2900 LOUISIANA BLVD NE
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3532
Mailing Address - Country:US
Mailing Address - Phone:505-880-0400
Mailing Address - Fax:505-880-0404
Practice Address - Street 1:2900 LOUISIANA BLVD NE
Practice Address - Street 2:SUITE A-2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3532
Practice Address - Country:US
Practice Address - Phone:505-880-0400
Practice Address - Fax:505-880-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3235251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM327201Medicare Oscar/Certification