Provider Demographics
NPI:1407268642
Name:PRAIRIE PINES COMMUNITY
Entity Type:Organization
Organization Name:PRAIRIE PINES COMMUNITY
Other - Org Name:ESSENTIA HEALTH FOSSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODENSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-435-7633
Mailing Address - Street 1:900 HILLIGOSS BLVD SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1542
Mailing Address - Country:US
Mailing Address - Phone:218-435-1134
Mailing Address - Fax:701-364-8476
Practice Address - Street 1:903 PRAIRE PINES DRIVE
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542
Practice Address - Country:US
Practice Address - Phone:218-435-7682
Practice Address - Fax:701-364-8476
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CARE MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-22
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN364748310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility