Provider Demographics
NPI:1285040535
Name:PROSPERITY IN-HOME HEALTH CARE SERVICEC, LLC
Entity type:Organization
Organization Name:PROSPERITY IN-HOME HEALTH CARE SERVICEC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-828-5207
Mailing Address - Street 1:PO BOX 2534
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR
Practice Address - Street 2:STE 2525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3300
Practice Address - Country:US
Practice Address - Phone:757-828-5207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERITY IN-HOME HEALTH CARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCOMedicaid