Provider Demographics
NPI:1942667423
Name:PRESTIGE MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:PRESTIGE MEDICAL SOLUTIONS
Other - Org Name:PRESTIGE BEHAVIORAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHEREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-925-3844
Mailing Address - Street 1:4662 N.W. 107 AVENUE #1903
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:786-703-6218
Mailing Address - Fax:
Practice Address - Street 1:13701 SW 88TH ST STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1309
Practice Address - Country:US
Practice Address - Phone:786-703-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty