Provider Demographics
NPI:1104145051
Name:PROSPECT HOME CARE SERVICES,LLC
Entity type:Organization
Organization Name:PROSPECT HOME CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BEDU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-934-2330
Mailing Address - Street 1:685 NORTH CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3778
Mailing Address - Country:US
Mailing Address - Phone:704-934-2330
Mailing Address - Fax:704-934-2335
Practice Address - Street 1:685 NORTH CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-3778
Practice Address - Country:US
Practice Address - Phone:704-934-2330
Practice Address - Fax:704-934-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3981251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care