1891778981 NPI number — PRAIRIE MANOR, INC.

Table of Contents

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 © 2007-2026 www.npivalidator.com