Provider Demographics
NPI:1801939798
Name:PROSPECT, INC.
Entity type:Organization
Organization Name:PROSPECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-444-0597
Mailing Address - Street 1:960 MADDOX SIMPSON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-0751
Mailing Address - Country:US
Mailing Address - Phone:615-444-0597
Mailing Address - Fax:615-444-1251
Practice Address - Street 1:960 MADDOX SIMPSON PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-0751
Practice Address - Country:US
Practice Address - Phone:615-444-0597
Practice Address - Fax:615-444-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000018006253Z00000X, 251E00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445127Medicaid