Provider Demographics
NPI:1073149217
Name:PRAIRIE WIND HOSPICE LLC
Entity Type:Organization
Organization Name:PRAIRIE WIND HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCIACCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-970-0733
Mailing Address - Street 1:4006 ROUTE 9 S
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1577
Mailing Address - Country:US
Mailing Address - Phone:732-970-0733
Mailing Address - Fax:
Practice Address - Street 1:606 HIGH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN CITY
Practice Address - State:KS
Practice Address - Zip Code:66006
Practice Address - Country:US
Practice Address - Phone:718-942-3483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based