| NPI | 1275113565 |
|---|---|
| Former Legal Business Name | PRESTIGE SENIOR CARE |
| Entity Type | Organization |
| Authorized Contact | KIMBERLY MIX Owner 904-545-5481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2021-04-11 |