MEDICARE: PRELUDE BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility	NONE LISTED	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68211	OTHER	IA	WELLMARK PROVIDER NUMBER

General Provider Information

NPI Number	:	1588615355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRELUDE BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	430 SOUTHGATE AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4425
Country	:	US
Telephone Number	:	319-351-4357
Fax Number	:	319-341-0085

Provider Business Practice Location Address
First Line	:	430 SOUTHGATE AVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4425
Country	:	US
Telephone Number	:	319-351-4357
Fax Number	:	319-341-0085

Authorized Official
Title or Position	:	CFO
Name	:	CHRISTINE RUSSELL
Credential	:
Telephone Number	:	319-351-4357

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/06/2019

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