Provider Demographics
NPI:1730445271
Name:PROSPERITY CARE LLC
Entity type:Organization
Organization Name:PROSPERITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEONDRA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:HARDEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-434-7700
Mailing Address - Street 1:4006 RIPPLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5518
Mailing Address - Country:US
Mailing Address - Phone:713-434-7700
Mailing Address - Fax:713-434-7703
Practice Address - Street 1:4006 RIPPLEBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5518
Practice Address - Country:US
Practice Address - Phone:713-434-7700
Practice Address - Fax:713-434-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270912557302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1982889655OtherHOME COMMUNITY BASED SERVICE PROVIDER