Healthcare Provider Details

I. General information

NPI: 1093262743
Provider Name (Legal Business Name): PROSPECT, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 MADDOX SIMPSON PKWY
LEBANON TN
37090-0751
US

IV. Provider business mailing address

960 MADDOX SIMPSON PKWY
LEBANON TN
37090-0751
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-0597
  • Fax: 615-444-1251
Mailing address:
  • Phone: 615-444-0597
  • Fax: 615-444-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberL3(20)4M6-076-3449
License Number StateTN

VIII. Authorized Official

Name: AUDRIA FRATTINI
Title or Position: DIRECTOR OF EMPLOYMENT SERVICES
Credential:
Phone: 615-444-0597