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General NPI Number Information
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NPI Number | 1134159452
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Entity Type | Organization
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Legal Business Name | PRAIRIE MISSION RETIREMENT VILLAGE
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 242 CARROLL ST
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City | SAINT PAUL
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State | KS
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Zip | 66771-4044
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Country | US
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Telephone | 620-449-2400
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Fax | 620-449-2564
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Provider Business Mailing Address
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Address Line | 242 CARROLL ST
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City | SAINT PAUL
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State | KS
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Zip | 66771-4044
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Country | US
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Telephone | 620-449-2400
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Fax | 620-449-2564
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BRENDA K. THORNTON
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Credential |
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Telephone | 620-449-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | N-067-007
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License Number State | KS
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