MEDICARE: VILLAGE OF PRAIRIE FARM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1056	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932107463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE OF PRAIRIE FARM

Provider Business Mailing Address
First Line	:	530 RIVER AVENUE SOUTH
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762
Country	:	US
Telephone Number	:	715-455-1178
Fax Number	:	715-455-1044

Provider Business Practice Location Address
First Line	:	530 RIVER AVENUE SOUTH
Second Line	:
City	:	PRAIRIE FARM
State	:	WI
Zip	:	54762
Country	:	US
Telephone Number	:	715-455-1178
Fax Number	:	715-455-1044

Authorized Official
Title or Position	:	CEO
Name	:	AMY DUHR
Credential	:
Telephone Number	:	715-832-3003

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/01/2023

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