Provider Demographics
NPI:1346552809
Name:PROSPERITY IN-HOME HEALTH CARE
Entity Type:Organization
Organization Name:PROSPERITY IN-HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-318-6416
Mailing Address - Street 1:PO BOX 2534
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-2534
Mailing Address - Country:US
Mailing Address - Phone:540-318-6416
Mailing Address - Fax:
Practice Address - Street 1:2152 JEFFERSON DAVIS HWY
Practice Address - Street 2:C
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7281
Practice Address - Country:US
Practice Address - Phone:540-318-6416
Practice Address - Fax:540-318-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346552809Medicaid