Provider Demographics
NPI:1760010243
Name:PRAIRIELAND HEALTH SERVICE, LLC
Entity Type:Organization
Organization Name:PRAIRIELAND HEALTH SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAWAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-378-9375
Mailing Address - Street 1:814 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1508
Mailing Address - Country:US
Mailing Address - Phone:414-378-9375
Mailing Address - Fax:
Practice Address - Street 1:814 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1508
Practice Address - Country:US
Practice Address - Phone:414-378-9375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care