Provider Demographics
NPI:1215703780
Name:PRESTIGE SUPPORT SERVICES
Entity type:Organization
Organization Name:PRESTIGE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAUTRUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-535-0429
Mailing Address - Street 1:44 COOPER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4639
Mailing Address - Country:US
Mailing Address - Phone:856-579-4245
Mailing Address - Fax:856-997-9098
Practice Address - Street 1:44 COOPER ST STE 1
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4639
Practice Address - Country:US
Practice Address - Phone:856-579-4245
Practice Address - Fax:856-997-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management