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General NPI Number Information
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NPI Number | 1780157610
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Entity Type | Organization
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Legal Business Name | PROSPERITY WELLNESS INC
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Dates
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Enumeration Date | 01/03/2019
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 20351 SW ACACIA ST FL 1
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1527
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Country | US
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Telephone | 714-615-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 10525 VISTA SORRENTO PKWY STE 310
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City | SAN DIEGO
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State | CA
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Zip | 92121-2748
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Country | US
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Telephone | 714-615-5915
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOEL W EDWARDS
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Credential |
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Telephone | 714-615-5915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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