Provider Demographics
NPI:1528258977
Name:MARION COUNTY HORIZON CENTER D/B/A PRAIRIE ESTATES
Entity type:Organization
Organization Name:MARION COUNTY HORIZON CENTER D/B/A PRAIRIE ESTATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARMBRUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-0309
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:122 NORTH HOTZE RD
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0745
Mailing Address - Country:US
Mailing Address - Phone:618-548-0309
Mailing Address - Fax:618-548-3720
Practice Address - Street 1:403 N STATE RD
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-1519
Practice Address - Country:US
Practice Address - Phone:618-662-9440
Practice Address - Fax:618-662-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0036277315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6288103Medicaid