Provider Demographics
NPI:1538607668
Name:PRESTIGE BEHAVIORAL PARTIAL & MEMORY CARE CENTER INC
Entity type:Organization
Organization Name:PRESTIGE BEHAVIORAL PARTIAL & MEMORY CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-470-5644
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-0247
Mailing Address - Country:US
Mailing Address - Phone:888-676-6768
Mailing Address - Fax:888-794-6717
Practice Address - Street 1:250 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3626
Practice Address - Country:US
Practice Address - Phone:888-676-6768
Practice Address - Fax:888-794-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty