National Provider Identifier Database

PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
Assisted Living Facility

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.


Contact Information

PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
200 INTERNATIONAL DRIVE
RANTOUL, IL61866
Phone: 217-892-2800
Fax: 217-892-2833
Website:
Specialty Taxonomy Code
* Assisted Living Facility 310400000X
Alzheimer Center /Dementia Center/Dementia Special Care Unit 311500000X

* Indicates primary specialty

NPI Profile & details for PRAIRIE VILLAGE SUPPORTIVE LIVING LLC

NPI Number 1518339167
Legal business name
LBN
PRAIRIE VILLAGE SUPPORTIVE LIVING LLC
Authorized official JOELLEN BLEAVINS - (VICE PRESIDENT OF MANAGEMENT AGENT)
Entity Organization
Organization subpart Yes
Enumeration date 10/22/2015
Last updated 11/03/2015 - About 11 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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