MEDICARE: PROSPERITY HOMECARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1205442597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPERITY HOMECARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	3232 N CAMPBELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6165
Country	:	US
Telephone Number	:	702-752-2114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 N CAMPBELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6165
Country	:	US
Telephone Number	:	702-752-2114
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT/ADMINISTRATOR
Name	:	PETRONE HAWKINS
Credential	:
Telephone Number	:	702-752-2114

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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