Healthcare Provider Details

I. General information

NPI: 1952921579
Provider Name (Legal Business Name): PROSPERITY HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 LINCOLN DR E STE 201
MARLTON NJ
08053-3105
US

IV. Provider business mailing address

419 NORTHFIELD AVE
WEST ORANGE NJ
07052-3091
US

V. Phone/Fax

Practice location:
  • Phone: 201-762-5090
  • Fax: 551-210-1912
Mailing address:
  • Phone: 201-762-5090
  • Fax: 551-210-1912

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: JOHNY EUGENE
Title or Position: CEO
Credential: MD, FNLP, CEO
Phone: 845-281-9722