Healthcare Provider Details

I. General information

NPI: 1205774676
Provider Name (Legal Business Name): PRAIRIE PERSONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 34TH ST
SIOUX FALLS SD
57105-4810
US

IV. Provider business mailing address

405 W 34TH ST
SIOUX FALLS SD
57105-4810
US

V. Phone/Fax

Practice location:
  • Phone: 952-923-0165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: AMIR HASSAN
Title or Position: OWNER
Credential:
Phone: 763-338-0167