Provider Demographics
NPI:1619151867
Name:PRAIRIE VALLEY CSD
Entity Type:Organization
Organization Name:PRAIRIE VALLEY CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-352-5571
Mailing Address - Street 1:1005 RIDDLE ST
Mailing Address - Street 2:BOX 49
Mailing Address - City:GOWRIE
Mailing Address - State:IA
Mailing Address - Zip Code:50543-7730
Mailing Address - Country:US
Mailing Address - Phone:515-352-5571
Mailing Address - Fax:
Practice Address - Street 1:1005 RIDDLE ST
Practice Address - Street 2:BOX 49
Practice Address - City:GOWRIE
Practice Address - State:IA
Practice Address - Zip Code:50543-7730
Practice Address - Country:US
Practice Address - Phone:515-352-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA461053Medicaid