Provider Demographics
NPI:1396038758
Name:PRAIRIE INVESTORS, L.L.C.
Entity type:Organization
Organization Name:PRAIRIE INVESTORS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-387-1000
Mailing Address - Street 1:450 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1701
Mailing Address - Country:US
Mailing Address - Phone:402-387-1000
Mailing Address - Fax:402-387-1015
Practice Address - Street 1:450 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1701
Practice Address - Country:US
Practice Address - Phone:402-387-1000
Practice Address - Fax:402-387-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF046310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========/00Medicaid