Provider Demographics
NPI:1891778981
Name:PRAIRIE MANOR, INC.
Entity Type:Organization
Organization Name:PRAIRIE MANOR, INC.
Other - Org Name:PRAIRIE MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-599-2031
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:1050 EDWIN ELLIOT DR.
Mailing Address - City:PINE PRAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70576-0500
Mailing Address - Country:US
Mailing Address - Phone:337-599-2031
Mailing Address - Fax:337-599-2548
Practice Address - Street 1:1050 EDWIN ELLIOTT DR.
Practice Address - Street 2:
Practice Address - City:PINE PRAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70576
Practice Address - Country:US
Practice Address - Phone:337-599-2031
Practice Address - Fax:337-599-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA452314000000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19E379Medicaid
LA195577Medicare ID - Type Unspecified
MP5893100001Medicare NSC