Provider Demographics
NPI:1700454162
Name:PRESTIGE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PRESTIGE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON-JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, FNP, CRNP
Authorized Official - Phone:410-978-6577
Mailing Address - Street 1:9722 GROFFS MILL DRIVE SUIT 823
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-978-6577
Mailing Address - Fax:
Practice Address - Street 1:9722 GROFFS MILL DRIVE SUIT 823
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-978-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care