Provider Demographics
NPI:1043445547
Name:PROSPERITAS, LLC
Entity Type:Organization
Organization Name:PROSPERITAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-756-9535
Mailing Address - Street 1:PO BOX 1793
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-1793
Mailing Address - Country:US
Mailing Address - Phone:336-756-9535
Mailing Address - Fax:888-682-9095
Practice Address - Street 1:172 W INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3566
Practice Address - Country:US
Practice Address - Phone:336-756-9535
Practice Address - Fax:888-682-9095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST GEORGIA REHABILITATION CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies