A Prospering Vision Holistic Medical Services, LLC
Organization Active NPI Nurse Practitioner · Waterbury, CT
NPI 1003280157 · NPPES record last updated Nov 30, 2015
Key facts
- NPI
- 1003280157
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- A PROSPERING VISION HOLISTIC MEDICAL SERVICES, LLC
- Practice address
- 60 N Main St
3Rd FLR
Waterbury, CT 06702-1443 - Phone
- (203) 558-9865
- NPI assigned
- Nov 30, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- A PROSPERING VISION, LLC
Authorized official
- Name
- Mr. Elijah Caldwell, LCSW
- Title
- Executive Director
- Phone
- (203) 558-9865
Parent organization (reported in NPPES) 1
Practitioners 2
-
Elijah Caldwell, LCSW
-
Nicholas James O'Brien, PMHNP
National Provider Directory
- Part of
- A Prospering Vision LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
60 N Main St
3Rd FLR
Waterbury, CT 06702-1443
Mailing address
60 N Main St
3Rd FLR
Waterbury, CT 06702-1443
Phone (203) 558-9865
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008042640 | Medicaid | CT |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.