Provider Demographics
NPI:1497420152
Name:PROSPERITY OF CARE LLC
Entity Type:Organization
Organization Name:PROSPERITY OF CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-274-1459
Mailing Address - Street 1:2186 HWY 11 N
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39439
Mailing Address - Country:US
Mailing Address - Phone:601-274-1459
Mailing Address - Fax:
Practice Address - Street 1:2186 HWY 11 N
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39439
Practice Address - Country:US
Practice Address - Phone:601-274-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care