Healthcare Provider Details

I. General information

NPI: 1952230963
Provider Name (Legal Business Name): CI PROSPERITY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 OLD BAY DR
PATASKALA OH
43062-7899
US

IV. Provider business mailing address

238 OLD BAY DR
PATASKALA OH
43062-7899
US

V. Phone/Fax

Practice location:
  • Phone: 217-693-8722
  • Fax: 999-999-9999
Mailing address:
  • Phone: 217-693-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER INYINDJOLOHANGA
Title or Position: MANAGING MEMBERS
Credential:
Phone: 217-693-8722