1891778981 NPI number — PRAIRIE MANOR, INC.

Table of content: (NPI 1891778981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891778981 NPI number — PRAIRIE MANOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE MANOR, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891778981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
1050 EDWIN ELLIOT DR.
Provider Business Mailing Address City Name:
PINE PRAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70576-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-599-2031
Provider Business Mailing Address Fax Number:
337-599-2548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 EDWIN ELLIOTT DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE PRAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-599-2031
Provider Business Practice Location Address Fax Number:
337-599-2548
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOOK
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
337-599-2031

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 452 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 19E379 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com