Provider Demographics
NPI:1477634236
Name:PRAIRIE VIEW MANAGEMENT, INC.
Entity Type:Organization
Organization Name:PRAIRIE VIEW MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-422-5606
Mailing Address - Street 1:18569 LANE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:IA
Mailing Address - Zip Code:52142-9525
Mailing Address - Country:US
Mailing Address - Phone:563-422-5606
Mailing Address - Fax:563-422-5607
Practice Address - Street 1:18569 LANE RD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:IA
Practice Address - Zip Code:52142-9525
Practice Address - Country:US
Practice Address - Phone:563-422-5606
Practice Address - Fax:563-422-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-279311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0107847Medicaid
IA1234484Medicaid
IA0893800Medicaid