Healthcare Provider Details

I. General information

NPI: 1912711086
Provider Name (Legal Business Name): PROSPER HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 AMARYLLIS LN
EAGAN MN
55123-1702
US

IV. Provider business mailing address

1374 AMARYLLIS LN
EAGAN MN
55123-1702
US

V. Phone/Fax

Practice location:
  • Phone: 952-393-1497
  • Fax:
Mailing address:
  • Phone: 952-393-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NAIMA HIRE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 952-393-1497