Organization
PRAIRIE VILLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATH BROUWER (ADMINISTRATOR)
(605) 724-2159
Entity
Organization
Contact information
Practice address
1309 BRADDOCK ST, ARMOUR, SD 57313-2102
(605) 724-2159
(605) 724-2310
Mailing address
1309 BRADDOCK ST, ARMOUR, SD 57313-2102
(605) 724-2159
(605) 724-2310
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9570570
—
SD
Enumeration date
11/22/2005
Last updated
12/06/2011
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