Provider Demographics
NPI:1194578591
Name:PROSPERITY HEALTHCARE AGENCY
Entity type:Organization
Organization Name:PROSPERITY HEALTHCARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-269-3121
Mailing Address - Street 1:4801 SOUTHWICK DR STE 630-H
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2254
Mailing Address - Country:US
Mailing Address - Phone:708-269-3121
Mailing Address - Fax:
Practice Address - Street 1:4801 SOUTHWICK DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2254
Practice Address - Country:US
Practice Address - Phone:708-269-3121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERITY HEALTHCARE AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-08
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care