| NPI | 1073714507 |
|---|---|
| Doing Business As | PRAIRIE CREEK |
| Entity Type | Organization |
| Authorized Contact | BRANDI TRAUTMAN Licensing Coordinator 682-707-2756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2025-04-28 |