Provider Demographics
NPI:1023889896
Name:PRESTIGE THERAPY, LLC
Entity type:Organization
Organization Name:PRESTIGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:DEBORAH
Authorized Official - Last Name:SUERTH
Authorized Official - Suffix:
Authorized Official - Credentials:ED, LCPC
Authorized Official - Phone:708-590-9870
Mailing Address - Street 1:23965 S OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1020
Mailing Address - Country:US
Mailing Address - Phone:708-590-9870
Mailing Address - Fax:
Practice Address - Street 1:10062 W 190TH PL STE 114
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8757
Practice Address - Country:US
Practice Address - Phone:708-590-9870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare