Healthcare Provider Details

I. General information

NPI: 1063326072
Provider Name (Legal Business Name): PRAIRIE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 SW 16TH ST
TOPEKA KS
66612-1826
US

IV. Provider business mailing address

518 SW 16TH ST
TOPEKA KS
66612-1826
US

V. Phone/Fax

Practice location:
  • Phone: 785-220-1138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: LARAY GREEN
Title or Position: OWNER/OPERATOR
Credential:
Phone: 785-220-1138