NPIMap

Organization Active NPI

Prairie Lakes Youth Programs Boys Group Home

  • Children's Substance Abuse Rehabilitation Facility
  • Willmar, MN
National Provider Identifier
1679750426
Registry record updated Jan 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
License
1049804-1-CRF Issued in MN
Legal business name
PRAIRIE LAKES YOUTH PROGRAMS BOYS GROUP HOME
Practice address
1013 Lakeland Dr NE
Willmar, MN 56201-2114
Phone
(320) 235-6895
Fax
(320) 231-3818
NPI assigned
Jan 23, 2008
Last updated
Jan 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2008

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

Authorized official

Name
Joyce K. McGillivray
Title
Accounts Manager
Phone
(320) 235-0975

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X 1049804-1-CRF MN Primary

Addresses

Primary practice location

1013 Lakeland Dr NE
Willmar, MN 56201-2114

Mailing address

1804 Civic Center Dr
PO Box 902
Willmar, MN 56201-9446
Phone (320) 235-0975

National Provider Directory

National Provider Directory
Tax ID family
Prairie Lakes Youth Programs3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1679750426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 CIVIC CENTER DR",
            "address_2": "PO BOX 902",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562019446",
            "telephone_number": "320-235-0975",
            "fax_number": "320-214-7067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 LAKELAND DR NE",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562012114",
            "telephone_number": "320-235-6895",
            "fax_number": "320-231-3818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE LAKES YOUTH PROGRAMS BOYS GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "MCGILLIVRAY",
        "authorized_official_first_name": "JOYCE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "320-235-0975"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MN",
            "license": "1049804-1-CRF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willmar, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; 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.