Provider Demographics
NPI:1285295030
Name:PROSPERITY HOME CARE, LLC
Entity type:Organization
Organization Name:PROSPERITY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-350-8637
Mailing Address - Street 1:3276 BUFORD DR STE 104-280
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5702
Mailing Address - Country:US
Mailing Address - Phone:470-350-8637
Mailing Address - Fax:206-401-5911
Practice Address - Street 1:1422 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3990
Practice Address - Country:US
Practice Address - Phone:470-350-8637
Practice Address - Fax:206-401-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care