1649236860 NPI number — PRESTIGE-PLUS HEALTH SERVICES INC

Table of content: (NPI 1649236860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649236860 NPI number — PRESTIGE-PLUS HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESTIGE-PLUS HEALTH SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649236860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 RAINTREE CIR STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-4935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-747-0821
Provider Business Mailing Address Fax Number:
972-747-9215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 RAINTREE CIR STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-747-0821
Provider Business Practice Location Address Fax Number:
972-747-9215
Provider Enumeration Date:
04/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OKONKWO
Authorized Official First Name:
CHINYERE
Authorized Official Middle Name:
EMILIA
Authorized Official Title or Position:
ADMINISTRATOR/DON
Authorized Official Telephone Number:
972-747-0821

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 010294 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162780401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180864001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".