Prairie Bluffs Tcu, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PRAIRIE BLUFFS TCU, LLC

Practice address

10300 Hennepin Town Rd
Eden Prairie, MN 55347-5100

Phone

(952) 444-5000

Fax

(952) 204-3024

NPI assigned

Aug 4, 2020

Organization subpart

No

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

Authorized official

Name

Chris Krebsbach, LNHA

Title

Coo

Phone

(612) 202-4553

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1770193872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 HENNEPIN TOWN ROAD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "55347",
            "telephone_number": "952-444-5000",
            "fax_number": "952-204-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 HENNEPIN TOWN RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553475100",
            "telephone_number": "952-444-5000",
            "fax_number": "952-204-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE BLUFFS TCU, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-04",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A",
        "authorized_official_last_name": "KREBSBACH",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-202-4553",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409168",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; 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.