1194800227 NPI number — REGION II HUMAN SERVICES

Table of content: (NPI 1245919299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194800227 NPI number — REGION II HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGION II HUMAN SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEARTLAND COUNSELING CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194800227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 WEST 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OGALLALA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-284-6767
Provider Business Mailing Address Fax Number:
308-284-3084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1012 WEST THIRD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCOOK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-345-2770
Provider Business Practice Location Address Fax Number:
308-345-2557
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
308-534-0440

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01822 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: DR6570 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070450 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".




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