| Organization Name: | PRAIRIE MANOR, INC. |
| NPI Number: | 1891778981 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA BOOK (ADMINISTRATOR) |
| Mailing Address: | 1050 Edwin Elliott Dr. Pine Prairie |
| State: | LA US |
| Postal Code: | 70576 |
| Phone Number: | 3375992031 |
| Fax Number: | 3375992548 |
| NPI Enumeration Date: | 11/22/2005 |
| NPI Last Update Date: | 12/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |