Provider Demographics
NPI:1770822926
Name:PRAIRIE VIEW ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:PRAIRIE VIEW ASSISTED LIVING, LLC
Other - Org Name:PRAIRIE VIEW ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:ALA
Authorized Official - Phone:402-368-2250
Mailing Address - Street 1:100 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:TILDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68781-8118
Mailing Address - Country:US
Mailing Address - Phone:402-368-2250
Mailing Address - Fax:402-368-2254
Practice Address - Street 1:100 S PINE ST
Practice Address - Street 2:
Practice Address - City:TILDEN
Practice Address - State:NE
Practice Address - Zip Code:68781-8118
Practice Address - Country:US
Practice Address - Phone:402-368-2250
Practice Address - Fax:402-368-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF346310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility