Provider Demographics
NPI:1457926305
Name:PRESTIGE BEHAVIORAL CENTER LLC
Entity Type:Organization
Organization Name:PRESTIGE BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-789-0041
Mailing Address - Street 1:2105 SW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3514
Mailing Address - Country:US
Mailing Address - Phone:239-789-0041
Mailing Address - Fax:
Practice Address - Street 1:2105 SW 20TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3514
Practice Address - Country:US
Practice Address - Phone:239-789-0041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center