Provider Demographics
NPI:1427810597
Name:PROLIFIC HOME CARE LLC
Entity type:Organization
Organization Name:PROLIFIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANGANIKA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:CNA/CMA/CPT
Authorized Official - Phone:478-867-9143
Mailing Address - Street 1:133 HIDDEN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5267
Mailing Address - Country:US
Mailing Address - Phone:478-867-9143
Mailing Address - Fax:
Practice Address - Street 1:133 HIDDEN CREEK CIR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5267
Practice Address - Country:US
Practice Address - Phone:478-867-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care