Provider Demographics
NPI:1487740858
Name:PROSPERING AT LIFE INC.
Entity type:Organization
Organization Name:PROSPERING AT LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HODA
Authorized Official - Middle Name:D
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-670-8626
Mailing Address - Street 1:210 SALZEDO ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1020
Mailing Address - Country:US
Mailing Address - Phone:561-670-8626
Mailing Address - Fax:
Practice Address - Street 1:210 SALZEDO ST
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1020
Practice Address - Country:US
Practice Address - Phone:561-670-8626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL678968496Medicaid