NPIMap

Organization Active NPI

Prairie Manor

  • Skilled Nursing Facility
  • Wilsonville, OR
National Provider Identifier
1164844866
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
057001429 Issued in IL
Legal business name
PRAIRIE MANOR
Practice address
25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697
Phone
(708) 754-7601
NPI assigned
Jan 15, 2014
Organization subpart
Yes
Parent organization
YESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Authorized official

Name
Mrs. Rosemarie M Smith, COTA/L
Title
Certified Occupational Therapy Assi
Phone
(708) 474-3116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 057001429 IL Primary

Addresses

Primary practice location

25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697

Mailing address

25117 SW Parkway Ave
Suite D
Wilsonville, OR 97070-9697

National Provider Directory

National Provider Directory
Tax ID family
Sante of North Scottsdale47 organizations share this tax ID, including this one
Part of
Sante of North Scottsdale

Other organizations with this tax ID 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1164844866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE",
            "address_2": "SUITE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25117 SW PARKWAY AVE",
            "address_2": "SUITE D",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709697",
            "telephone_number": "708-754-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MANOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "YES",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROSEMARIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CERTIFIED OCCUPATIONAL THERAPY ASSI",
        "authorized_official_telephone_number": "708-474-3116",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "COTA/L"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "057001429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilsonville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.