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General NPI Number Information
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NPI Number | 1730520099
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Entity Type | Organization
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Legal Business Name | PRAIRIE RIVER HOME CARE
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 25 1ST AVE NE
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City | BUFFALO
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State | MN
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Zip | 55313-1568
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Country | US
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Telephone | 763-868-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 25 1ST AVE NE
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City | BUFFALO
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State | MN
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Zip | 55313-1568
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Country | US
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Telephone | 763-868-2300
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Fax |
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Authorized Official
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Title or Position | RN CASE MANAGER
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Name | TAMERA MARIE PIERCE
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Credential | RN
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Telephone | 612-508-8449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R-203669-0
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License Number State | MN
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