Provider Demographics
NPI:1508829821
Name:HOSPICE OF THE PRAIRIE, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE PRAIRIE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-7209
Mailing Address - Street 1:200 4TH CIR
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2400
Mailing Address - Country:US
Mailing Address - Phone:620-227-7209
Mailing Address - Fax:620-227-7429
Practice Address - Street 1:200 4TH CIR
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2400
Practice Address - Country:US
Practice Address - Phone:620-227-7209
Practice Address - Fax:620-227-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA029005251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100242670AMedicaid
KS100242670AMedicaid