Provider Demographics
NPI:1467480640
Name:PRAIRIE LAKES HEALTH CARE SYSTEMS INC
Entity Type:Organization
Organization Name:PRAIRIE LAKES HEALTH CARE SYSTEMS INC
Other - Org Name:PRAIRIE LAKES HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURBAK
Authorized Official - Suffix:
Authorized Official - Credentials:CNO
Authorized Official - Phone:605-882-7000
Mailing Address - Street 1:401 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1548
Mailing Address - Country:US
Mailing Address - Phone:605-882-7000
Mailing Address - Fax:605-882-7607
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-7000
Practice Address - Fax:605-882-7607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE LAKES HEALTH CARS SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0154030Medicaid
SD0154030Medicaid