Prolific Life Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROLIFIC LIFE SERVICES

Practice address

4615 W Broad St
Richmond, VA 23230-3243

Phone

(804) 234-4084

Fax

(804) 915-1229

NPI assigned

Feb 2, 2023

Last updated

Nov 15, 2023By 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. Darius Robinson

Title

Program Manager

Phone

(804) 234-4084

Specialties & licenses 1

Addresses

Other names 1

• Prolific Life Services Other name

Locations

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

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1780380691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4615 W BROAD ST STE 123",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232303243",
            "telephone_number": "804-234-4084",
            "fax_number": "804-915-1229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4615 W BROAD ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232303243",
            "telephone_number": "804-234-4084",
            "fax_number": "804-915-1229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIFIC LIFE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-02",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "DARIUS",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "804-234-4084",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prolific Life Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Prolific Life Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.