Healthcare Provider Details

I. General information

NPI: 1952248437
Provider Name (Legal Business Name): PROSPERITY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 118E
BEVERLY MA
01915-6114
US

IV. Provider business mailing address

22 PIEDMONT ST
SALEM MA
01970-4619
US

V. Phone/Fax

Practice location:
  • Phone: 978-574-9988
  • Fax: 617-885-0493
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KYLE ROQUE
Title or Position: PRESIDENT
Credential: DR
Phone: 617-830-9205