Provider Demographics
NPI:1952044943
Name:PRELUDE CORPORATION
Entity Type:Organization
Organization Name:PRELUDE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-294-1274
Mailing Address - Street 1:26051 MERIT CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7008
Mailing Address - Country:US
Mailing Address - Phone:888-211-3247
Mailing Address - Fax:
Practice Address - Street 1:60 LAUREL RIDGE RD
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2513
Practice Address - Country:US
Practice Address - Phone:888-211-3247
Practice Address - Fax:888-909-3247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRELUDE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39D2243493OtherCLIA