Provider Demographics
NPI:1912207317
Name:PASSPORT 2 PROSPERITY INCORPORATED
Entity Type:Organization
Organization Name:PASSPORT 2 PROSPERITY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-583-4940
Mailing Address - Street 1:265 REDDING RDG
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8027
Mailing Address - Country:US
Mailing Address - Phone:404-583-4940
Mailing Address - Fax:770-306-6068
Practice Address - Street 1:265 REDDING RDG
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-8027
Practice Address - Country:US
Practice Address - Phone:404-583-4940
Practice Address - Fax:770-306-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health