Organization
PROSPEROUS HEALTH IMPERIAL BEACH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY SHIREY (PRESIDENT)
(619) 669-3295
Entity
Organization
Contact information
Practice address
107 DAISY AVE, IMPERIAL BEACH, CA 91932
(833) 364-4722
Mailing address
9909 HUENNEKENS ST STE 110, SAN DIEGO, CA 92121-2928
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/05/2025
Last updated
06/23/2025
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