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General NPI Number Information
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NPI Number | 1285295030
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Entity Type | Organization
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Legal Business Name | PROSPERITY HOME CARE, LLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 1422 FOUNTAIN VIEW DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3990
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Country | US
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Telephone | 470-350-8637
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Fax | 206-401-5911
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Provider Business Mailing Address
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Address Line | 3276 BUFORD DR STE 104-280
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City | BUFORD
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State | GA
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Zip | 30519-5702
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Country | US
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Telephone | 470-350-8637
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Fax | 206-401-5911
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMELIA MICHELLE SOLOMON
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Credential |
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Telephone | 470-350-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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