Provider Demographics
NPI:1851626410
Name:PRAIRIE HILLS AT DES MOINES OPERATIONS LLC
Entity Type:Organization
Organization Name:PRAIRIE HILLS AT DES MOINES OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/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:
Authorized Official - Phone:641-472-0518
Mailing Address - Street 1:500 N 3RD ST STE 206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2483
Mailing Address - Country:US
Mailing Address - Phone:641-472-0518
Mailing Address - Fax:
Practice Address - Street 1:5815 SE 27TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-2759
Practice Address - Country:US
Practice Address - Phone:515-256-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility