Provider Demographics
NPI:1891195608
Name:PRAIRIE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PRAIRIE COMMUNITY SERVICES
Other - Org Name:ROLLINGWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-589-4919
Mailing Address - Street 1:801 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1865
Mailing Address - Country:US
Mailing Address - Phone:320-589-3077
Mailing Address - Fax:320-589-4955
Practice Address - Street 1:2203 ROLLING GREEN LN
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-4459
Practice Address - Country:US
Practice Address - Phone:507-779-7187
Practice Address - Fax:507-779-7186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST, FRANCIS HEALTH SERVICES OF MORRIS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities