Provider Demographics
NPI:1588615355
Name:PRELUDE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:PRELUDE BEHAVIORAL SERVICES
Other - Org Name:(FORMERLY MECCA SERVICES)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-351-4357
Mailing Address - Street 1:430 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4425
Mailing Address - Country:US
Mailing Address - Phone:319-351-4357
Mailing Address - Fax:319-341-0085
Practice Address - Street 1:430 SOUTHGATE AVE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4425
Practice Address - Country:US
Practice Address - Phone:319-351-4357
Practice Address - Fax:319-341-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
IANONE LISTED324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA68211OtherWELLMARK PROVIDER NUMBER