PRAIRIE HILLS AT TIPTON OPERATIONS LLC NPI 1700091915

NPI Information

NPI: 1700091915
Provider Name: PRAIRIE HILLS AT TIPTON OPERATIONS, LLC

Former Legal Business Name: SUNNYBROOK MANAGEMENT, LLC DBA PRAIRIE HILLS SENIOR SERVICES

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

Address:
219 S CEDAR ST
TIPTON, IA
ZIP 52772
Phone: (563) 886-1584
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PRAIRIE HILLS AT TIPTON OPERATIONS, LLC is an assisted living facility in Tipton, IA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PRAIRIE HILLS AT TIPTON OPERATIONS, LLC NPI is 1700091915. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Sunnybrook Management, Llc Dba Prairie Hills Senior Services.

The provider's business location address is:

219 S CEDAR ST
TIPTON, IA
ZIP 52772-764
Phone: (563) 886-1584
Fax: (563) 886-9101

The provider's authorized official is Timothy R Hildebrandt .
The authorized official title is Owner and has the following contact phone number (641) 472-0518.

The CLIA number assigned to this NPI record is 16D1066876 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/11/2007 and was last updated on 10/9/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0462192	MEDICAID	IOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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