Healthcare Provider Details

I. General information

NPI: 1881216430
Provider Name (Legal Business Name): PROSPER HOME HEALTH AND TRANSPORTATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2020
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 COLFAX AVE S
BLOOMINGTON MN
55431-3133
US

IV. Provider business mailing address

10025 COLFAX AVE S
BLOOMINGTON MN
55431-3133
US

V. Phone/Fax

Practice location:
  • Phone: 612-876-1187
  • Fax:
Mailing address:
  • Phone: 612-876-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: IFRAH D ALI
Title or Position: RN AND ADMINISTRATOR
Credential: RN AND ADMINISTRATOR
Phone: 858-877-0066