Provider Demographics
NPI:1912310541
Name:PRESTIGIOUS PROVIDER SERVICES
Entity type:Organization
Organization Name:PRESTIGIOUS PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HYLTON
Authorized Official - Middle Name:V
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-551-4501
Mailing Address - Street 1:4703 CASHEL GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-3534
Mailing Address - Country:US
Mailing Address - Phone:832-551-4501
Mailing Address - Fax:
Practice Address - Street 1:4703 CASHEL GLEN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-3534
Practice Address - Country:US
Practice Address - Phone:832-551-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITIAN NURSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016207251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health