Healthcare Provider Details

I. General information

NPI: 1346177169
Provider Name (Legal Business Name): PROLIFIC LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 ELBRIDGE ST
PHILADELPHIA PA
19135-3027
US

IV. Provider business mailing address

4141 ELBRIDGE ST
PHILADELPHIA PA
19135-3027
US

V. Phone/Fax

Practice location:
  • Phone: 267-575-4908
  • Fax:
Mailing address:
  • Phone: 267-575-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOSE MARTINEZ JR.
Title or Position: CEO
Credential:
Phone: 267-575-4908