Provider Demographics
NPI:1821721994
Name:PROSPERITY SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:PROSPERITY SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-244-2252
Mailing Address - Street 1:1455 ANITA ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2815
Mailing Address - Country:US
Mailing Address - Phone:337-244-2252
Mailing Address - Fax:
Practice Address - Street 1:1455 ANITA ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2815
Practice Address - Country:US
Practice Address - Phone:337-244-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility