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NPI Code Detail

MEDICARE: PROSPEROUS BEGINNINGS, LLC

MEDICARE: PROSPEROUS BEGINNINGS, 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
1261QM0850XAdult Mental Health Clinic/Center
2320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1356057913
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPEROUS BEGINNINGS, LLC
Provider Business Mailing Address
First Line : 1911 POWHATAN AVE
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-1925
Country : US
Telephone Number : 804-805-2127
Fax Number : 804-805-7901
Provider Business Practice Location Address
First Line : 1911 POWHATAN AVE
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-1925
Country : US
Telephone Number : 804-805-2127
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : SHANEE FLEMING
Credential :
Telephone Number : 804-805-2127
Provider Enumeration Date : 01/26/2023
Last Update Date : 10/30/2024

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Directions to “PROSPEROUS BEGINNINGS, LLC ” Practice Location

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