Provider Demographics
NPI:1902892409
Name:PRAIRIE REHABILITATION SERVICES, INC.
Entity Type:Organization
Organization Name:PRAIRIE REHABILITATION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLASOE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:605-334-5630
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X
MN022510002332B00000X
SD0225410001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9204836OtherDAKOTACARE
MN9206761OtherDAKOTACARE
SD4998209OtherBLUE CROSS BLUE SHEILD SD
SD4998216OtherBLUE CROSS BLUE SHIELD SD
SD596595OtherARAZ
SD8B713PROtherBLUE CROSS BLUE SHIELD MN
SD9213674OtherDAKOTACARE
MN16G65PROtherBLUE CROSS BLUE SHEILD MN
SD4998553OtherBLUE CROSS BLUE SHEILD SD
MN9G902PROtherBLUE CROSS BLUE SHIELD MN
MN3730832-00OtherMHCP
SD4994838OtherBLUE CROSS BLUE SHIELD SD
SD9G904PROtherBLUE CROSS BLUE SHEILD MN
MN123082OtherU CARE
SD16G67PROtherBLUE CROSS BLUE SHEILD MN
SD8736521OtherDAKOTACARE
MN8B710PROtherBLUE CROSS BLUE SHIELD MN
SD9226612OtherDAKOTACARE
SD9213674OtherDAKOTACARE
SD4998209OtherBLUE CROSS BLUE SHEILD SD
SD8B713PROtherBLUE CROSS BLUE SHIELD MN
MN9206761OtherDAKOTACARE