Provider Demographics
NPI:1447444278
Name:PRAIRIE LAKES HOME CONNECTIONS
Entity type:Organization
Organization Name:PRAIRIE LAKES HOME CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-882-7851
Mailing Address - Street 1:PO BOX 1210
Mailing Address - Street 2:401 9TH AVE NW
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6210
Mailing Address - Country:US
Mailing Address - Phone:605-882-7841
Mailing Address - Fax:605-882-6703
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-7841
Practice Address - Fax:605-882-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage