Prairie Lakes Youth Programs Girls Group Home

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

1049805-1-CRF Issued in MN

Legal business name

PRAIRIE LAKES YOUTH PROGRAMS GIRLS GROUP HOME

Practice address

822 Park Ave
Willmar, MN 56201-2568

Phone

(320) 235-6637

Fax

(320) 235-6659

NPI assigned

Jan 23, 2008

Organization subpart

No

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

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• Prairie Lakes Youth Programs

  • Counselor
  • Willmar, MN
  • NPI 1699958777
  NPD tax ID
• Prairie Lakes Youth Programs Boys Group Home

  • Children's Substance Abuse Rehabilitation Facility
  • Willmar, MN
  • NPI 1679750426
  NPD tax ID

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": "1831376680",
    "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": "822 PARK AVE",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562012568",
            "telephone_number": "320-235-6637",
            "fax_number": "320-235-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE LAKES YOUTH PROGRAMS GIRLS 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": "1049805-1-CRF",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greta Kay Postma, PCA
• Laura Pouliot
• Prairie Lakes Therapies, Inc.
• Prairie Lakes Youth Programs
• Prairie Lakes Youth Programs Boys Group Home
• Kellie Ann Prentice, FNP - BC
• Priority Mental Health, LLC
• Carmelita Regina Privatt, LPCC
• Jenna Prusa, LICSW
• Dean Douglas Quale, D.D.S.

• Children's Substance Abuse Rehabilitation Facility in Willmar, MN
• Providers in Willmar, MN by specialty
• Children's Substance Abuse Rehabilitation Facility in Minnesota

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.