Provider Demographics
NPI:1609626811
Name:PROSPERITY HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:PROSPERITY HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:DANYALE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:124-859-5378
Mailing Address - Street 1:2059 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2085
Mailing Address - Country:US
Mailing Address - Phone:248-595-3788
Mailing Address - Fax:
Practice Address - Street 1:2059 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2085
Practice Address - Country:US
Practice Address - Phone:248-595-3788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health