Provider Demographics
NPI:1962276238
Name:PRAIRIE GRACE HOSPICE LLC
Entity type:Organization
Organization Name:PRAIRIE GRACE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:507-720-8597
Mailing Address - Street 1:1028 N RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3340
Mailing Address - Country:US
Mailing Address - Phone:507-821-0430
Mailing Address - Fax:
Practice Address - Street 1:1028 N RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3340
Practice Address - Country:US
Practice Address - Phone:507-821-0430
Practice Address - Fax:507-540-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based