NPIMap

Organization Active NPI

Kiowa County

Doing business as Prairie Pines Assisted Living Community

  • Assisted Living Facility
  • Eads, CO
National Provider Identifier
1114068442
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL0992 Issued in CO
Legal business name
KIOWA COUNTY
Doing business as
Prairie Pines Assisted Living Community
Practice address
101 E Lowell Avenue
Eads, CO 81036-0787
Phone
(719) 438-2141
Fax
(719) 438-2140
NPI assigned
Feb 9, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Pamela Sue Weirich
Title
Administrator
Phone
(719) 438-2141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL0992 CO Primary

Addresses

Primary practice location

101 E Lowell Avenue
Eads, CO 81036-0787

Mailing address

Box 787
101 E Lowell Avenue
Eads, CO 81036-0787
Phone (719) 438-2141

Other identifiers 1

IdentifierTypeStateIssuer
28621786MedicaidCO

Other names 1

  • Prairie Pines Assisted Living Community Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kiowa County4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

101 E Lowell Ave
Eads, CO 81036
Phone (719) 438-2141

NPI Registry JSON

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114068442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 787",
            "address_2": "101 E LOWELL AVENUE",
            "city": "EADS",
            "state": "CO",
            "postal_code": "810360787",
            "telephone_number": "719-438-2141",
            "fax_number": "719-438-2140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E LOWELL AVENUE",
            "city": "EADS",
            "state": "CO",
            "postal_code": "810360787",
            "telephone_number": "719-438-2141",
            "fax_number": "719-438-2140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOWA COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WEIRICH",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "719-438-2141",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CO",
            "license": "AL0992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28621786",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Pines Assisted Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eads, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.