Provider Demographics
NPI:1386723468
Name:PRAIRIE REHABILITATION SERVICES, INC.
Entity type:Organization
Organization Name:PRAIRIE REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASOE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:605-334-5630
Mailing Address - Street 1:1220 E. HOLLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005
Mailing Address - Country:US
Mailing Address - Phone:605-582-3103
Mailing Address - Fax:605-582-3103
Practice Address - Street 1:1220 E. HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005
Practice Address - Country:US
Practice Address - Phone:605-582-3103
Practice Address - Fax:605-582-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies