Provider Demographics
NPI:1780280958
Name:BIG PRAIRIE ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:BIG PRAIRIE ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:573-683-1355
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MO
Mailing Address - Zip Code:63870-0456
Mailing Address - Country:US
Mailing Address - Phone:573-683-1355
Mailing Address - Fax:
Practice Address - Street 1:411 NORTH KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801
Practice Address - Country:US
Practice Address - Phone:573-471-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility