Provider Demographics
NPI:1275045718
Name:PROSPER INCORPORATED
Entity Type:Organization
Organization Name:PROSPER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:KEEPING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-284-7772
Mailing Address - Street 1:701 CENTER AVE E
Mailing Address - Street 2:
Mailing Address - City:DILWORTH
Mailing Address - State:MN
Mailing Address - Zip Code:56529-1410
Mailing Address - Country:US
Mailing Address - Phone:218-284-7772
Mailing Address - Fax:
Practice Address - Street 1:701 CENTER AVE E
Practice Address - Street 2:
Practice Address - City:DILWORTH
Practice Address - State:MN
Practice Address - Zip Code:56529-1410
Practice Address - Country:US
Practice Address - Phone:218-284-7772
Practice Address - Fax:218-284-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care