Provider Demographics
NPI:1942780259
Name:PRESTIGE KARE YOUTH & FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:PRESTIGE KARE YOUTH & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEYISHA
Authorized Official - Middle Name:SHENNNETTE
Authorized Official - Last Name:LAMPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-364-4717
Mailing Address - Street 1:706 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3710
Mailing Address - Country:US
Mailing Address - Phone:757-938-5004
Mailing Address - Fax:757-938-5015
Practice Address - Street 1:706 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3710
Practice Address - Country:US
Practice Address - Phone:757-938-5004
Practice Address - Fax:757-938-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639553027Medicaid