- Enrollment id
- O20050808000114
- Enrollment state
- WI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1487656765
- Multiple npi flag
- N
- Ccn
- 525525
- Associate id
- 4688603962
- Organization name
- PRAIRIE NURSING FACILITY LLC
- Doing business as name
- PRAIRIE MAISON
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- PRAIRIE MAISON
- Address line 1
- 700 S FREMONT ST
- City
- PRAIRIE DU CHIEN
- State
- WI
- Zip code
- 538212331