Prospera Healthcare Michigan LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROSPERA HEALTHCARE MICHIGAN LLC

Practice address

402 W 2ND St
Rochester, MI 48307-1904

Phone

(248) 770-9929

NPI assigned

Sep 23, 2021

Last updated

Sep 23, 2021By 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

Kyle Coddington

Title

Coo

Phone

(972) 900-2488

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632355200000",
    "number": "1255002812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SADDLE DR",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750286011",
            "telephone_number": "972-900-2488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W 2ND ST",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071904",
            "telephone_number": "248-770-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPERA HEALTHCARE MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "CODDINGTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "972-900-2488"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; 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.