MEDICARE: PRAIRIE HILLS MEALS PROGRAM

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
1	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1710232434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE HILLS MEALS PROGRAM

Provider Business Mailing Address
First Line	:	2015 TUMBLEWEED TRL
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-8810
Country	:	US
Telephone Number	:	605-642-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 EAST AVE
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-3307
Country	:	US
Telephone Number	:	605-642-6613
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BARBARA K CLINE
Credential	:
Telephone Number	:	605-642-6613

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/18/2012

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