Prosperous Health Imperial Beach, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PROSPEROUS HEALTH IMPERIAL BEACH, LLC

Practice address

107 Daisy Ave
Imperial Beach, CA 91932

Phone

(833) 364-4722

NPI assigned

Mar 5, 2025

Last updated

Jun 23, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerry Shirey

Title

President

Phone

(619) 669-3295

Specialties & licenses 2

Addresses

Tax ID family

Prosperous Health Imperial Beach LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prosperous Health San Diego, LLC

  dba San Diego Transformation Center

  • Adult Mental Health Clinic/Center
  • San Diego, CA
  • NPI 1245037019
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750636800000",
    "number": "1124826011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9909 HUENNEKENS ST STE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 DAISY AVE",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "91932",
            "telephone_number": "833-364-4722"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 Daisy Ave",
            "address_purpose": "LOCATION",
            "city": "Imperial Beach",
            "state": "CA",
            "postal_code": "91932",
            "country_code": "US",
            "telephone_number": "833-364-4722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROSPEROUS HEALTH IMPERIAL BEACH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "SHIREY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-669-3295",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris D Patton, D.D.S.
• Emily Elizabeth Perrine, PSYD
• Linda Petrie
• Vernon Greg Phillips, MD
• Frances McDonald Pratte, LMFT
• Michael Steve Quirozayala
• Renuka Rajiv, NP
• RDN Foundation Inc.
• Christina Reiter, CNM
• Danielle Richardson, M.D.

• Substance Abuse Rehabilitation Facility in Imperial Beach, CA
• Providers in Imperial Beach, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.