Provider Demographics
NPI:1609665702
Name:FLOURISHING AT HOME LLC
Entity type:Organization
Organization Name:FLOURISHING AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISCHELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FORTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-376-1302
Mailing Address - Street 1:165 KEYSTONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5093
Mailing Address - Country:US
Mailing Address - Phone:229-376-1302
Mailing Address - Fax:
Practice Address - Street 1:165 KEYSTONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5093
Practice Address - Country:US
Practice Address - Phone:229-376-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care