Provider Demographics
NPI:1942313283
Name:PRAIRIE RIDGE VILLAGE
Entity Type:Organization
Organization Name:PRAIRIE RIDGE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SWINDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-230-2459
Mailing Address - Street 1:521 4TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2434
Mailing Address - Country:US
Mailing Address - Phone:406-228-2208
Mailing Address - Fax:406-228-4208
Practice Address - Street 1:521 4TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2434
Practice Address - Country:US
Practice Address - Phone:406-228-2208
Practice Address - Fax:406-228-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9566OtherDPHHS RESIDENTIAL HEALTH
MT0700553Medicaid
MT9566OtherDPHHS RESIDENTIAL HEALTH