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General NPI Number Information
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NPI Number | 1902296783
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Entity Type | Organization
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Legal Business Name | PROSPERIN 21 ST LLC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 12/27/2016
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Provider Practice Location Address
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Address Line | 301 EDGEWATER PL
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City | WAKEFIELD
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State | MA
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Zip | 01880-1293
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Country | US
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Telephone | 781-856-0539
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Fax | 781-584-6983
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Provider Business Mailing Address
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Address Line | 301 EDGEWATER PLACE SUITE 100
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City | WAKEFIELD
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State | MA
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Zip | 01880-6234
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Country | US
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Telephone | 781-842-3035
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Fax | 781-584-6983
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Authorized Official
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Title or Position | PRESIDENT/ SECRETARY
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Name | JEANNETTE MUKANDORI NDAHUNGA
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Credential | LPN
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Telephone | 781-856-0539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | MA
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