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General NPI Number Information
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NPI Number | 1447419148
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Entity Type | Organization
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Legal Business Name | PROSPERITY HEALTH CARE
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 11628 S CHOCTAW DR STE 227
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City | BATON ROUGE
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State | LA
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Zip | 70815-2107
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Country | US
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Telephone | 225-275-5999
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Fax | 225-275-6611
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Provider Business Mailing Address
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Address Line | 11628 S CHOCTAW DR STE 227
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City | BATON ROUGE
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State | LA
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Zip | 70815-2107
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Country | US
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Telephone | 225-275-5999
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Fax | 225-275-6611
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Authorized Official
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Title or Position | CO- OWNER
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Name | ERICA RAYFORD
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Credential |
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Telephone | 225-275-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 1020028
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License Number State | LA
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