Prairie Ridge Integrated Health Care

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

PRAIRIE RIDGE INTEGRATED HEALTH CARE

Practice address

320 N Eisenhower Ave
Mason City, IA 50401-1521

Phone

(641) 424-2391

NPI assigned

Nov 22, 2016

Last updated

Nov 22, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Baker, TCADC

Title

Clinician

Phone

(641) 530-8055

Specialties & licenses 1

Addresses

Other names 1

• Addiction Services Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479772800000",
    "number": "1043753056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504011521",
            "telephone_number": "641-424-2391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N EISENHOWER AVE",
            "city": "MASON CITY",
            "state": "IA",
            "postal_code": "504011521",
            "telephone_number": "641-424-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE RIDGE INTEGRATED HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-22",
        "last_updated": "2016-11-22",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CLINICIAN",
        "authorized_official_telephone_number": "641-530-8055",
        "authorized_official_credential": "TCADC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Addiction Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Aileen R Prabhakaran, MD
• Sarah Prahm, APRN
• Prairie Ridge Integrated Behavioral Healthcare (Prairie Ridge)
• Prairie Ridge Integrated Behavioral Healthcare (Prairie Ridge)
• Prairie Ridge Integrated Behavioral Healthcare (Prairie Ridge)
• Michelle Elizabeth Pralle, BA
• Vickie M Pralle, BA
• Brittany Ann Promes, LMSW
• Paul L Pulford, SA-C
• Sara Jean Puttmann, BA CADC

• Substance Abuse Rehabilitation Facility in Mason City, IA
• Providers in Mason City, IA by specialty
• Substance Abuse Rehabilitation Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.