Provider Demographics
NPI:1922709005
Name:PROSPEROUS HOME CARE OF MINNESOTA LLC
Entity Type:Organization
Organization Name:PROSPEROUS HOME CARE OF MINNESOTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-376-7615
Mailing Address - Street 1:PO BOX 90122
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109-0122
Mailing Address - Country:US
Mailing Address - Phone:605-376-7615
Mailing Address - Fax:605-408-8340
Practice Address - Street 1:14150 210TH ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-3160
Practice Address - Country:US
Practice Address - Phone:605-376-7615
Practice Address - Fax:605-408-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care