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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