Healthcare Provider Details

I. General information

NPI: 1942112016
Provider Name (Legal Business Name): PRAIRIE PINES ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E LOWELL AVE
EADS CO
81036-9683
US

IV. Provider business mailing address

9440 GOLDEN OAK PL
PARKER CO
80134-4544
US

V. Phone/Fax

Practice location:
  • Phone: 720-382-9288
  • Fax:
Mailing address:
  • Phone: 720-382-9288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PARUL DARJI
Title or Position: OWNER
Credential:
Phone: 720-382-9288