Provider Demographics
NPI:1609633700
Name:PROSPERS HOME HEATH AGENCY LLC
Entity Type:Organization
Organization Name:PROSPERS HOME HEATH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-412-2626
Mailing Address - Street 1:1268 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9748
Mailing Address - Country:US
Mailing Address - Phone:803-412-2626
Mailing Address - Fax:
Practice Address - Street 1:1268 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9748
Practice Address - Country:US
Practice Address - Phone:803-412-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health