Healthcare Provider Details

I. General information

NPI: 1205745247
Provider Name (Legal Business Name): PROSPEROUS HEALTH LAKE HUGHES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49713 GORMAN POST RD
LEBEC CA
93243-9701
US

IV. Provider business mailing address

28632 ROADSIDE DR STE 210
AGOURA HILLS CA
91301-6091
US

V. Phone/Fax

Practice location:
  • Phone: 818-274-6376
  • Fax:
Mailing address:
  • Phone: 818-274-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN DAVID MEINTS JR.
Title or Position: CEO
Credential:
Phone: 818-274-6376