1447286356 NPI number — PRAIRIE LIVING CENTER, L.P.

Table of content: (NPI 1447286356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447286356 NPI number — PRAIRIE LIVING CENTER, L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE LIVING CENTER, L.P.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRAIRIE HOUSE LIVING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447286356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 DRYDEN ROAD
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
DRESHER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19025-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-441-7700
Provider Business Mailing Address Fax Number:
215-441-4255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 MESA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-293-4855
Provider Business Practice Location Address Fax Number:
806-293-2804
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LICARI
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT OF GENERAL PARTNER
Authorized Official Telephone Number:
215-441-7700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  115199 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 118925 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 118925 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001013627 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021947901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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