Provider Demographics
NPI:1497946628
Name:PRAIRIE HILLS AT OTTUMWA OPERATIONS LLC
Entity Type:Organization
Organization Name:PRAIRIE HILLS AT OTTUMWA OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILDEBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-0518
Mailing Address - Street 1:500 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2485
Mailing Address - Country:US
Mailing Address - Phone:641-472-0518
Mailing Address - Fax:
Practice Address - Street 1:173 E ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501
Practice Address - Country:US
Practice Address - Phone:641-684-1871
Practice Address - Fax:641-684-5827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0259310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility