Provider Demographics
NPI:1811659279
Name:NORTHLAND PRAIRIE CARE LLC
Entity type:Organization
Organization Name:NORTHLAND PRAIRIE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:320-226-7178
Mailing Address - Street 1:544 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2106
Mailing Address - Country:US
Mailing Address - Phone:320-321-1181
Mailing Address - Fax:320-321-1388
Practice Address - Street 1:544 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2106
Practice Address - Country:US
Practice Address - Phone:320-321-1181
Practice Address - Fax:320-321-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care