# PRAIRIE HARBOR, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235565797
- **Authorized official:** RANDALL BRYANT (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (979) 217-1581

## Contact information

- **Practice address:** 7146 HIGHWAY 60, WALLIS, TX 77485-9507
- **Practice address phone:** (979) 217-1581
- **Mailing address:** PO BOX 517, WALLIS, TX 77485-0517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | — | Yes |

## Other

- **Enumeration date:** 09/16/2013
- **Last updated:** 02/28/2014