Healthcare Provider Details

I. General information

NPI: 1083777585
Provider Name (Legal Business Name): PRAIRIE VIEW, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E 1ST ST
NEWTON KS
67114-5010
US

IV. Provider business mailing address

1901 E 1ST ST PO BOX 467
NEWTON KS
67114-5010
US

V. Phone/Fax

Practice location:
  • Phone: 316-284-6400
  • Fax: 316-284-6491
Mailing address:
  • Phone: 316-284-6400
  • Fax: 316-284-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARCY JOHNSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 316-284-6310