| NPI | 1952443632 |
|---|---|
| Doing Business As | PRAIRIE RIDGE |
| Entity Type | Organization |
| Authorized Contact | JAY HANSEN Executive Director 641-424-2391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: IA 1201) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IA 1201) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: IA 1201) | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: IA 1201) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2017-08-25 |