Basic Information
| Provider Information | |||||||||
| NPI: | 1326187493 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PANHANDLE MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4110 AVENUE D | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBLUFF | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693614650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086353171 | ||||||||
| FaxNumber: | 3086357026 | ||||||||
| Practice Location | |||||||||
| Address1: | 941 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691621736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082542649 | ||||||||
| FaxNumber: | 3082541014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 02/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDS | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3086353171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | SATC096 | NE | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 10025218100 | 05 | NE | MEDICAID |