Healthcare Provider Details

I. General information

NPI: 1588615355
Provider Name (Legal Business Name): PRELUDE BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SOUTHGATE AVE
IOWA CITY IA
52240-4425
US

IV. Provider business mailing address

430 SOUTHGATE AVE
IOWA CITY IA
52240-4425
US

V. Phone/Fax

Practice location:
  • Phone: 319-351-4357
  • Fax: 319-341-0085
Mailing address:
  • Phone: 319-351-4357
  • Fax: 319-341-0085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberNONE LISTED
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINE RUSSELL
Title or Position: CFO
Credential:
Phone: 319-351-4357