Prairie Grace Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PRAIRIE GRACE HOSPICE LLC

Practice address

1028 N Riverfront Dr
Mankato, MN 56001-3340

Phone

(507) 821-0430

Fax

(507) 540-1275

NPI assigned

Nov 8, 2023

Organization subpart

No

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

Authorized official

Name

Mr. Chad Werth, RN

Title

Administrator

Phone

(507) 720-8597

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Hospice certification: CCN 241624

Legal name

PRAIRIE GRACE HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 4, 2024

Last certification

Sep 6, 2024

Organization structure

LLCProprietary

Incorporated

Jul 17, 2023 in MN

Enrollment address

1028 N Riverfront Dr
Mankato, MN 56001-3340

Listed as

Prairie Grace Hospice, LLCCCN 241624

Certified

Oct 4, 2024

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1962276238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1028 N RIVERFRONT DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013340",
            "telephone_number": "507-821-0430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1028 N RIVERFRONT DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560013340",
            "telephone_number": "507-821-0430",
            "fax_number": "507-540-1275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "113 Ash Ave S",
            "address_purpose": "LOCATION",
            "city": "New Richland",
            "state": "MN",
            "postal_code": "560727513",
            "country_code": "US",
            "telephone_number": "507-463-3565",
            "fax_number": "507-463-3361",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1304 Birchwood Dr",
            "address_purpose": "LOCATION",
            "city": "New Ulm",
            "state": "MN",
            "postal_code": "560731063",
            "country_code": "US",
            "telephone_number": "507-359-3420",
            "fax_number": "507-359-3421",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "706 6th Ave NE",
            "address_purpose": "LOCATION",
            "city": "Isanti",
            "state": "MN",
            "postal_code": "550403207",
            "country_code": "US",
            "telephone_number": "763-444-4626",
            "fax_number": "763-645-1168",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1602 W Fountain St",
            "address_purpose": "LOCATION",
            "city": "Albert Lea",
            "state": "MN",
            "postal_code": "560071667",
            "country_code": "US",
            "telephone_number": "507-379-9000",
            "fax_number": "507-373-1880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1310 Bradford St SE",
            "address_purpose": "LOCATION",
            "city": "Hutchinson",
            "state": "MN",
            "postal_code": "553503302",
            "country_code": "US",
            "telephone_number": "320-587-5508",
            "fax_number": "320-587-7491",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 19th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Willmar",
            "state": "MN",
            "postal_code": "562014944",
            "country_code": "US",
            "telephone_number": "202-356-0223",
            "fax_number": "320-235-6029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRAIRIE GRACE HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-08",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "WERTH",
        "authorized_official_first_name": "CHAD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-720-8597",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rachael Suzanne Potter, O.D.
• Clinton John Prasnicki, CRNA
• Theresa M. Pratt, RD
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• Suzanne Mary Prestridge, M.A.

• Community Based Hospice Care Agency in Mankato, MN
• Providers in Mankato, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.