Provider Demographics
NPI:1700091915
Name:PRAIRIE HILLS AT TIPTON OPERATIONS, LLC
Entity Type:Organization
Organization Name:PRAIRIE HILLS AT TIPTON OPERATIONS, LLC
Other - Org Name:SUNNYBROOK MANAGEMENT, LLC DBA PRAIRIE HILLS SENIOR SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILDEBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING MEMBER
Authorized Official - Phone:641-472-0518
Mailing Address - Street 1:1680 HIGHWAY 1
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-9112
Mailing Address - Country:US
Mailing Address - Phone:641-472-0518
Mailing Address - Fax:641-472-0817
Practice Address - Street 1:219 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1764
Practice Address - Country:US
Practice Address - Phone:563-886-1584
Practice Address - Fax:563-886-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE HILLS AT TIPTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0462192Medicaid