Provider Demographics
NPI:1003286287
Name:PROSPEROUS, LLC
Entity Type:Organization
Organization Name:PROSPEROUS, LLC
Other - Org Name:CEDAR TREE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-559-3001
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-7165
Mailing Address - Country:US
Mailing Address - Phone:267-559-3001
Mailing Address - Fax:302-595-3149
Practice Address - Street 1:131 BECKS WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:MD
Practice Address - Zip Code:19701
Practice Address - Country:US
Practice Address - Phone:267-559-3001
Practice Address - Fax:302-595-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty