Provider Demographics
NPI:1316120686
Name:PRAIRIELAND PRIVATE DUTY
Entity type:Organization
Organization Name:PRAIRIELAND PRIVATE DUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-663-2229
Mailing Address - Street 1:409 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1517
Mailing Address - Country:US
Mailing Address - Phone:815-664-2413
Mailing Address - Fax:
Practice Address - Street 1:409 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1517
Practice Address - Country:US
Practice Address - Phone:815-664-2413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health