PROSPEROUS HEALTH IMPERIAL BEACH, LLC – NPI #1124826011
Substance Abuse Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

Health Care Provider Taxonomy Code for Substance Abuse Rehabilitation Facility

PROSPEROUS HEALTH IMPERIAL BEACH, LLC is a substance abuse rehabilitation facility located in IMPERIAL BEACH, CA. NPPES has assigned the NPI number 1124826011 to PROSPEROUS HEALTH IMPERIAL BEACH, LLC on March 05, 2025. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 324500000X from the Health Care Provider Taxonomy code set, which is classified as Substance Abuse Rehabilitation Facility.

The NPI profile was last updated on Jun 23, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROSPEROUS HEALTH IMPERIAL BEACH, LLC below.

NPI Profile for
PROSPEROUS HEALTH IMPERIAL BEACH, LLC

NPI Number
1124826011
Enumeration Date

(more than a year ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROSPEROUS HEALTH IMPERIAL BEACH, LLC
Primary location
107 DAISY AVE
IMPERIAL BEACH, CA 91932
Phone: (833) 364-4722 Fax:
1 Other location(s):
109 Daisy Ave
Imperial Beach, CA 91932
Phone: (833) 364-4722
Mailing address
9909 HUENNEKENS ST STE 110
SAN DIEGO, CA 92121-2928
Phone: Fax:
Organization Subpart
No
Authorized Official
JERRY SHIREY
PRESIDENT
Phone: (619) 669-3295
Updated
Certification Date
Jun 02, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
324500000X
- Substance Abuse Rehabilitation Facility (Primary)
261QR0405X
- Clinic/Center / Rehabilitation, Substance Use Disorder

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.