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General NPI Number Information
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NPI Number | 1093262743
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Entity Type | Organization
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Legal Business Name | PROSPECT, INCORPORATED
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 960 MADDOX SIMPSON PKWY
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City | LEBANON
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State | TN
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Zip | 37090-0751
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Country | US
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Telephone | 615-444-0597
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Fax | 615-444-1251
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Provider Business Mailing Address
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Address Line | 960 MADDOX SIMPSON PKWY
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City | LEBANON
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State | TN
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Zip | 37090-0751
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Country | US
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Telephone | 615-444-0597
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Fax | 615-444-1251
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Authorized Official
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Title or Position | DIRECTOR OF EMPLOYMENT SERVICES
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Name | AUDRIA FRATTINI
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Credential |
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Telephone | 615-444-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | L3(20)4M6-076-3449
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License Number State | TN
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