Provider Demographics
NPI:1144516824
Name:PRESTIGE HEALTHCARE RESOURCES INC.
Entity type:Organization
Organization Name:PRESTIGE HEALTHCARE RESOURCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SAYE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:240-644-3578
Mailing Address - Street 1:6011 EMERSON ST APT 209
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1829
Mailing Address - Country:US
Mailing Address - Phone:240-644-3578
Mailing Address - Fax:202-204-5758
Practice Address - Street 1:6011 EMERSON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710
Practice Address - Country:US
Practice Address - Phone:240-644-3578
Practice Address - Fax:202-204-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2022-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251B00000X, 261QM0850X
MDR3017P251E00000X
251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC018535185Medicaid
DC052557651Medicaid
DC095470341Medicaid
DC067587600Medicaid