=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811543721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSPERITY HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2019
-----------------------------------------------------
Last Update Date | 08/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5653 COLUMBIA PIKE STE 200
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-870-1670
-----------------------------------------------------
Fax | 703-544-9299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5653 COLUMBIA PIKE STE 200
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22041-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-870-1670
-----------------------------------------------------
Fax | 703-544-9299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINSTRATOR
-----------------------------------------------------
Name | AHMED MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-870-1670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------