Provider Demographics
NPI:1457836496
Name:PROSPERITY ARTS & CRAFT INC
Entity Type:Organization
Organization Name:PROSPERITY ARTS & CRAFT INC
Other - Org Name:PROSPERITY ARTS & CRAFT INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR/BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-949-0151
Mailing Address - Street 1:1012 E AVENUE J # 116
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3870
Mailing Address - Country:US
Mailing Address - Phone:661-949-0151
Mailing Address - Fax:661-466-1827
Practice Address - Street 1:2550 KENWOOD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1126
Practice Address - Country:US
Practice Address - Phone:661-208-8905
Practice Address - Fax:661-466-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid