Healthcare Provider Details

I. General information

NPI: 1427952928
Provider Name (Legal Business Name): PROSPERITY CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N 54TH ST
PHILADELPHIA PA
19131-3221
US

IV. Provider business mailing address

1004 CHILDS AVE
DREXEL HILL PA
19026-4028
US

V. Phone/Fax

Practice location:
  • Phone: 610-809-8421
  • Fax:
Mailing address:
  • Phone: 610-809-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PRINCETON MARQUIS WILLIAMS
Title or Position: OWNER
Credential:
Phone: 610-809-8421