Provider Demographics
NPI:1922356922
Name:PRAIRIE LIVING LLC
Entity Type:Organization
Organization Name:PRAIRIE LIVING LLC
Other - Org Name:KATY'S COTTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORKHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-715-5743
Mailing Address - Street 1:200 W INTERNATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:RANTOUL
Mailing Address - State:IL
Mailing Address - Zip Code:61866-3628
Mailing Address - Country:US
Mailing Address - Phone:217-892-2800
Mailing Address - Fax:217-892-2833
Practice Address - Street 1:200 W INTERNATIONAL AVE
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-3628
Practice Address - Country:US
Practice Address - Phone:217-892-2800
Practice Address - Fax:217-892-2833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHANUTE RETIREMENT JOINT VENTURE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)