Provider Demographics
NPI:1366044190
Name:PROSPER HOME CARE, LLC
Entity Type:Organization
Organization Name:PROSPER HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAVONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPROAPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-326-7220
Mailing Address - Street 1:1690 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8433
Mailing Address - Country:US
Mailing Address - Phone:314-326-7220
Mailing Address - Fax:
Practice Address - Street 1:1690 CLOVER LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8433
Practice Address - Country:US
Practice Address - Phone:314-326-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health