Healthcare Provider Details

I. General information

NPI: 1003722794
Provider Name (Legal Business Name): PRAIRIE HEARTS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BAY SHORE BND SE
MANDAN ND
58554-6260
US

IV. Provider business mailing address

3401 BAY SHORE BND SE
MANDAN ND
58554-6260
US

V. Phone/Fax

Practice location:
  • Phone: 701-333-8187
  • Fax: 701-333-8187
Mailing address:
  • Phone: 701-333-8187
  • Fax: 701-333-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: AMY NELSON
Title or Position: RN
Credential: NELSON
Phone: 701-333-8187