Provider Demographics
NPI:1265578207
Name:PROSPERITY HOME HEALTH SERVICES INC.
Entity type:Organization
Organization Name:PROSPERITY HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT CARE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:EVANS
Authorized Official - Middle Name:
Authorized Official - Last Name:ONIHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, PHN
Authorized Official - Phone:310-410-8433
Mailing Address - Street 1:6167 BRISTOL PKWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6610
Mailing Address - Country:US
Mailing Address - Phone:310-410-8433
Mailing Address - Fax:310-410-8484
Practice Address - Street 1:6167 BRISTOL PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6610
Practice Address - Country:US
Practice Address - Phone:310-410-8433
Practice Address - Fax:310-410-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058130Medicare Oscar/Certification