1346552809 NPI number — PROSPERITY IN-HOME HEALTH CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346552809 NPI number — PROSPERITY IN-HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSPERITY IN-HOME HEALTH CARE
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:
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:
1346552809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22555-2534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-318-6416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2152 JEFFERSON DAVIS HWY
Provider Second Line Business Practice Location Address:
C
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22554-7281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-318-6416
Provider Business Practice Location Address Fax Number:
540-318-6516
Provider Enumeration Date:
07/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
CHASITY
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
540-318-6416

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346552809 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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