1689036865 NPI number — SCENIC BLUFFS HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689036865 NPI number — SCENIC BLUFFS HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCENIC BLUFFS HEALTH CENTER, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1689036865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASHTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54619-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-654-5100
Provider Business Mailing Address Fax Number:
608-654-5120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E FRANKLIN ST RM B3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54656-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-654-5100
Provider Business Practice Location Address Fax Number:
608-654-5120
Provider Enumeration Date:
03/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FREIBERG
Authorized Official First Name:
MARI
Authorized Official Middle Name:
ROSE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
608-654-5100

Provider Taxonomy Codes

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

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





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