Basic Information
| Provider Information | |||||||||
| NPI: | 1467592063 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PANHANDLE MENTAL HEALTH CENTER DAY TREATMENT | ||||||||
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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: | 3701 AVENUE D | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SCOTTSBLUFF | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693614771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3086324412 | ||||||||
| FaxNumber: | 3086322326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOHLERS | ||||||||
| AuthorizedOfficialFirstName: | SHARYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3086353171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 89 | NE | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 10025265500 | 05 | NE | MEDICAID |