Healthcare Provider Details

I. General information

NPI: 1356132914
Provider Name (Legal Business Name): PROSPERITY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 N MAIN ST FL 2
PLYMOUTH MI
48170-1236
US

IV. Provider business mailing address

107 GREENWICH ST FL 14
NEW YORK NY
10006-1898
US

V. Phone/Fax

Practice location:
  • Phone: 616-438-0737
  • Fax:
Mailing address:
  • Phone: 616-438-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY YANG
Title or Position: SECRETARY
Credential:
Phone: 616-438-0737