Prairie View Creations Llc

LBN: Prairie View Creations Llc
Prairie View Creations Llc is an health care organization with primary practice located at 8508 N Prairie Vw , Prescott Valley AZ 86315-9089. The organization recently has 4 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Dietitian, Registered, Dietary & Nutritional Service Providers / Nutrition, Pediatric, Dietary & Nutritional Service Providers / Nutrition, Renal, Dietary & Nutritional Service Providers / Nutrition, Metabolic. Dietary & Nutritional Service Providers / Dietitian, Registered is the primary health care specialty. Prairie View Creations Llc can be contacted via phone (928) 772-8652, or through Hetherwick, Chad via phone (928) 772-8652.

Contact Information

Primary practice address
8508 N Prairie Vw Prescott Valley AZ 86315-9089
Phone: (928) 772-8652
Fax: (928) 772-8078
Website:
Map and Directions
Authorized official contact:
Name: Hetherwick, Chad MS, RD
Phone: (928) 772-8652

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X
Dietary & Nutritional Service Providers / Nutrition, Pediatric 133VN1004X
Dietary & Nutritional Service Providers / Nutrition, Renal 133VN1005X
Dietary & Nutritional Service Providers / Nutrition, Metabolic 133VN1006X

Profile Details

NPI number 1063979961
LBN Legal business name Prairie View Creations Llc
DBA Doing business as
Authorized official Hetherwick, Chad MS, RD
Entity Organization
Organization subpart 1 No
Enumeration date Feb 27th, 2019
Last updated Nov 3rd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063979961 NPPES
Arizona MEDICAID 488506

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