Provider Demographics
NPI:1992712590
Name:PROSPERITY PLACE - WHERE ALL THINGS ARE POSSIBLE
Entity type:Organization
Organization Name:PROSPERITY PLACE - WHERE ALL THINGS ARE POSSIBLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUETERSROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-347-3770
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:972-347-3770
Mailing Address - Fax:972-347-9790
Practice Address - Street 1:133 DYLAN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:972-347-3770
Practice Address - Fax:972-347-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation