Provider Demographics
NPI:1235836537
Name:PRAIRIE RIDGE HEALTH & REHABILITATION
Entity Type:Organization
Organization Name:PRAIRIE RIDGE HEALTH & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-836-4131
Mailing Address - Street 1:6501 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-3017
Mailing Address - Country:US
Mailing Address - Phone:913-383-9866
Mailing Address - Fax:913-393-1629
Practice Address - Street 1:6501 W 75TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-3017
Practice Address - Country:US
Practice Address - Phone:913-383-9866
Practice Address - Fax:913-393-1629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility