Provider Demographics
NPI:1679882922
Name:PRAIRIE VIEW THERAPEUTIC GROUP HOMES, INC.
Entity type:Organization
Organization Name:PRAIRIE VIEW THERAPEUTIC GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-936-2241
Mailing Address - Street 1:703 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1651
Mailing Address - Country:US
Mailing Address - Phone:574-936-2241
Mailing Address - Fax:
Practice Address - Street 1:703 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1651
Practice Address - Country:US
Practice Address - Phone:574-936-2241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty