Prairie Creek Village, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PRAIRIE CREEK VILLAGE, LLC

Practice address

2530 N Monroe St
Decatur, IL 62526-3249

Phone

(217) 875-0920

Fax

(217) 876-9351

NPI assigned

Jan 9, 2018

Last updated

Sep 15, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Winter, CPA

Title

Cfo

Phone

(847) 675-7979

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1033626254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6840 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607122628",
            "telephone_number": "847-674-5200",
            "fax_number": "847-675-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 N MONROE ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625263249",
            "telephone_number": "217-875-0920",
            "fax_number": "217-876-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE CREEK VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-09",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A",
        "authorized_official_last_name": "WINTER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "847-675-7979",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Potter, RPH
• Hailey Powell
• Manjeshwar B. Prabhu, M.D.
• Practice Management Associates LLC (Elite Care Center)
• Prairie Compounding Pharmacies Corporation (Prairie Compounding Pharmacy)
• Prairie Emergency Physicians, LLP
• Prairie Eye Center, LTD
• Prairie Oncology Management Services Pharmacy
• Prairieland Service Coordination Inc
• Rita A Prater Crouch, CRNA

• Skilled Nursing Facility in Decatur, IL
• Providers in Decatur, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.