Provider Demographics
NPI:1760698039
Name:PRAIRIE HILLS MANAGEMENT LLC
Entity Type:Organization
Organization Name:PRAIRIE HILLS MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:MANAGING MEMBER
Authorized Official - Phone:641-472-0518
Mailing Address - Street 1:500 N 3RD ST
Mailing Address - Street 2:SUITE 206
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:641-472-0817
Practice Address - Street 1:505 ENTERPRISE DR SW
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9603
Practice Address - Country:US
Practice Address - Phone:319-334-2000
Practice Address - Fax:319-334-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0483594Medicaid