Provider Demographics
NPI:1235602160
Name:PROSPERITY WELLNESS INC
Entity Type:Organization
Organization Name:PROSPERITY WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-615-5915
Mailing Address - Street 1:10525 VISTA SORRENTO PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2748
Mailing Address - Country:US
Mailing Address - Phone:714-615-5915
Mailing Address - Fax:
Practice Address - Street 1:1400 REYNOLDS AVE STE 205&206
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5559
Practice Address - Country:US
Practice Address - Phone:714-615-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility