Provider Demographics
NPI:1033632732
Name:FILLMORE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:FILLMORE COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PAWLWOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP, LADC
Authorized Official - Phone:402-759-3192
Mailing Address - Street 1:1900 F ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NE
Mailing Address - Zip Code:68361-2229
Mailing Address - Country:US
Mailing Address - Phone:402-759-3192
Mailing Address - Fax:402-759-3186
Practice Address - Street 1:1900 F STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NE
Practice Address - Zip Code:68361
Practice Address - Country:US
Practice Address - Phone:402-759-3192
Practice Address - Fax:402-759-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1457745119Medicaid
NE1457745119Medicaid