Healthcare Provider Details

I. General information

NPI: 1306059662
Provider Name (Legal Business Name): PRAIRIE VIEW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S. ASH
HILLSBORO KS
67063-0185
US

IV. Provider business mailing address

P.O. BOX 467 1901 E. 1ST ST.
NEWTON KS
67114-0467
US

V. Phone/Fax

Practice location:
  • Phone: 620-947-3200
  • Fax: 620-947-3845
Mailing address:
  • Phone: 316-284-6400
  • Fax: 316-284-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number00210714
License Number StateKS

VIII. Authorized Official

Name: JESSIE KAYE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 316-284-6400