Provider Demographics
NPI:1982064960
Name:PROSPERIN 21 ST LLC
Entity Type:Organization
Organization Name:PROSPERIN 21 ST LLC
Other - Org Name:HOME FOR LIFE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NDAHUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-842-3035
Mailing Address - Street 1:531 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3946
Mailing Address - Country:US
Mailing Address - Phone:781-856-0539
Mailing Address - Fax:781-584-6983
Practice Address - Street 1:531 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3946
Practice Address - Country:US
Practice Address - Phone:781-856-0539
Practice Address - Fax:781-584-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health