Provider Demographics
NPI:1609302629
Name:PROSPER HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROSPER HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIROSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-243-1313
Mailing Address - Street 1:1589 W 9TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5666
Mailing Address - Country:US
Mailing Address - Phone:909-243-1313
Mailing Address - Fax:909-363-9313
Practice Address - Street 1:1589 W 9TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5666
Practice Address - Country:US
Practice Address - Phone:909-243-1313
Practice Address - Fax:909-363-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163WHO200X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health