Provider Demographics
NPI:1457926305
Name:PRESTIGE BEHAVIORAL CENTER LLC
Entity type:Organization
Organization Name:PRESTIGE BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-789-0041
Mailing Address - Street 1:2105 SW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3514
Mailing Address - Country:US
Mailing Address - Phone:239-789-0041
Mailing Address - Fax:321-413-3808
Practice Address - Street 1:303 NE 3RD AVE STE 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2538
Practice Address - Country:US
Practice Address - Phone:239-257-1897
Practice Address - Fax:321-413-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center