Basic Information
| Provider Information | |||||||||
| NPI: | 1154928026 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEHAVIORAL HEALTH SPECIALISTS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | BHS PENDER CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W NORFOLK AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023703140 | ||||||||
| FaxNumber: | 4028443131 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PENDER | ||||||||
| State: | NE | ||||||||
| PostalCode: | 680475051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023703140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2020 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HAIAR | ||||||||
| AuthorizedOfficialFirstName: | SHARI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4023703140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIORAL HEALTH SPECIALISTS INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 10026053703 | 05 | NE | MEDICAID | 10026053701 | 05 | NE | MEDICAID | 10026053702 | 05 | NE | MEDICAID |