Provider Demographics
NPI:1073021283
Name:PRAIRIE OASIS, LLC
Entity Type:Organization
Organization Name:PRAIRIE OASIS, LLC
Other - Org Name:PRAIRIE OASIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-945-1000
Mailing Address - Street 1:8131 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3325
Mailing Address - Country:US
Mailing Address - Phone:773-945-1000
Mailing Address - Fax:
Practice Address - Street 1:16000 WABASH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1464
Practice Address - Country:US
Practice Address - Phone:708-339-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility