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NPI Code Detail

MEDICARE: PRAIRIE NURSING FACILITY LLC

MEDICARE: PRAIRIE NURSING FACILITY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility3170WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487656765
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRAIRIE NURSING FACILITY LLC
Provider Business Mailing Address
First Line : 700 S. FREMONT STREET
Second Line :
City : PRAIRIE DU CHIEN
State : WI
Zip : 53821
Country : US
Telephone Number : 608-326-8471
Fax Number : 608-326-3205
Provider Business Practice Location Address
First Line : 700 S. FREMONT STREET
Second Line :
City : PRAIRIE DU CHIEN
State : WI
Zip : 53821
Country : US
Telephone Number : 608-326-8471
Fax Number : 608-326-3205
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. MARY JO WOLCOTT
Credential :
Telephone Number : 608-326-8471
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/22/2009

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Directions to “PRAIRIE NURSING FACILITY LLC ” Practice Location

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