Provider Demographics
NPI:1285124495
Name:PRESTIGE HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:PRESTIGE HEALTH CARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISDORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYAMUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-757-7878
Mailing Address - Street 1:340 MAIN ST STE 977
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1600
Mailing Address - Country:US
Mailing Address - Phone:508-757-7878
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST STE 977
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1600
Practice Address - Country:US
Practice Address - Phone:508-757-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE HEALTH CARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency