Provider Demographics
NPI:1982888277
Name:OAKWOOD VILLAGE PRAIRIE RIDGE HOMES, INC
Entity type:Organization
Organization Name:OAKWOOD VILLAGE PRAIRIE RIDGE HOMES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:O DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-230-4466
Mailing Address - Street 1:6165 MINERAL POINT RD
Mailing Address - Street 2:ATTN: FINANCE DEPT
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4457
Mailing Address - Country:US
Mailing Address - Phone:608-230-4318
Mailing Address - Fax:608-230-4218
Practice Address - Street 1:5833 AMERICAN PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-230-4000
Practice Address - Fax:608-230-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility