Provider Demographics
NPI:1902296783
Name:PROSPERIN 21 ST LLC
Entity Type:Organization
Organization Name:PROSPERIN 21 ST LLC
Other - Org Name:HEALTHBRIDGE HOME CARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:MUKANDORI
Authorized Official - Last Name:NDAHUNGA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:781-856-0539
Mailing Address - Street 1:301 EDGEWATER PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-6234
Mailing Address - Country:US
Mailing Address - Phone:781-842-3035
Mailing Address - Fax:781-584-6983
Practice Address - Street 1:301 EDGEWATER PL
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1293
Practice Address - Country:US
Practice Address - Phone:781-856-0539
Practice Address - Fax:781-584-6983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERIN 21 ST LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-30
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health