Provider Demographics
NPI:1720558190
Name:PROSPERITY HOME CARE LLC
Entity Type:Organization
Organization Name:PROSPERITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATORYIA
Authorized Official - Middle Name:KATRICE
Authorized Official - Last Name:WADDLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-610-2671
Mailing Address - Street 1:46355 LAKESIDE PARK DR APT 204
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5548
Mailing Address - Country:US
Mailing Address - Phone:586-610-2671
Mailing Address - Fax:
Practice Address - Street 1:46355 LAKESIDE PARK DR APT 204
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-5548
Practice Address - Country:US
Practice Address - Phone:586-610-2671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health