Organization
PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE
Active
Organization
PRAIRIE RIDGE INTEGRATED BEHAVIORAL HEALTHCARE
Active
Other names
Prairie Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY HANSEN (EXECUTIVE DIRECTOR)
(641) 424-2391
Entity
Organization
Contact information
Practice address
320 N EISENHOWER AVE, MASON CITY, IA 50401-1521
(641) 424-2391
Mailing address
PO BOX 1338, MASON CITY, IA 50402-1338
(641) 424-2391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1201
IA
103TA0400X
Addiction (Substance Use Disorder) Psychologist
1201
IA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
1201
IA
324500000X
Substance Abuse Rehabilitation Facility
Primary
1201
IA
Other
Enumeration date
02/12/2007
Last updated
08/25/2017
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