Healthcare Provider Details

I. General information

NPI: 1316120686
Provider Name (Legal Business Name): PRAIRIELAND PRIVATE DUTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E 2ND ST
SPRING VALLEY IL
61362-1517
US

IV. Provider business mailing address

409 E 2ND ST
SPRING VALLEY IL
61362-1517
US

V. Phone/Fax

Practice location:
  • Phone: 815-664-2413
  • Fax:
Mailing address:
  • Phone: 815-664-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LINDA LEONE
Title or Position: CEO/PRESIDENT
Credential:
Phone: 815-663-2229