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General NPI Number Information
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NPI Number | 1437630910
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Entity Type | Organization
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Legal Business Name | PRELUDE HOMES & SERVICES
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 10020 RALEIGH RD
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City | WOODBURY
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State | MN
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Zip | 55129-5004
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Country | US
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Telephone | 651-501-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 355 COMMERCE CT
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City | VADNAIS HEIGHTS
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State | MN
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Zip | 55127-8506
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Country | US
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Telephone | 651-501-6517
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DEBORAH L ROSE
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Credential |
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Telephone | 651-501-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 385790
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License Number State | MN
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