Provider Demographics
NPI:1093262743
Name:PROSPECT, INCORPORATED
Entity Type:Organization
Organization Name:PROSPECT, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMPLOYMENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:AUDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-444-0597
Mailing Address - Street 1:960 MADDOX SIMPSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-0751
Mailing Address - Country:US
Mailing Address - Phone:615-444-0597
Mailing Address - Fax:615-444-1251
Practice Address - Street 1:960 MADDOX SIMPSON PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-0751
Practice Address - Country:US
Practice Address - Phone:615-444-0597
Practice Address - Fax:615-444-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M6-076-3449251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017618Medicaid