Provider Demographics
NPI:1295200772
Name:PRAIRIE COACHING LLC
Entity Type:Organization
Organization Name:PRAIRIE COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPCC
Authorized Official - Phone:612-916-8698
Mailing Address - Street 1:6910 TARTAN CURV
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-3360
Mailing Address - Country:US
Mailing Address - Phone:612-916-8698
Mailing Address - Fax:
Practice Address - Street 1:6910 TARTAN CURV
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-3360
Practice Address - Country:US
Practice Address - Phone:612-916-8698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA