Provider Demographics
NPI:1093851206
Name:THREE RIVERS, INC.
Entity Type:Organization
Organization Name:THREE RIVERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREMMER - PHILIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-456-9915
Mailing Address - Street 1:P.O. BOX 408
Mailing Address - Street 2:408 LINCOLN AVE.
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1632
Mailing Address - Country:US
Mailing Address - Phone:785-456-9915
Mailing Address - Fax:785-456-1419
Practice Address - Street 1:408 LINCOLN AVE.
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1632
Practice Address - Country:US
Practice Address - Phone:785-456-9915
Practice Address - Fax:785-456-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100020570C251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100020570AMedicaid
KS100020570CMedicaid