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General NPI Number Information
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NPI Number | 1912982083
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Entity Type | Organization
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Legal Business Name | PRAIRIE ACRES
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 201 E. 15TH STREET
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City | FRIONA
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State | TX
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Zip | 79035
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Country | US
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Telephone | 806-250-3922
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Fax | 806-250-2132
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Provider Business Mailing Address
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Address Line | 201 E. 15TH STREET
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City | FRIONA
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State | TX
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Zip | 79035
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Country | US
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Telephone | 806-250-3922
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Fax | 806-250-2132
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | NICHOLE M. BRISTER
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Credential | LNFA
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Telephone | 806-250-3922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126276
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 107250
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 111644
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 125044
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License Number State | TX
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