Provider Demographics
NPI:1164612818
Name:HEALTHNET REGIONAL CENTER OF CUBA, INC..
Entity Type:Organization
Organization Name:HEALTHNET REGIONAL CENTER OF CUBA, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FROESCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:573-885-5005
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:925 LAKESHORE DR
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453
Mailing Address - Country:US
Mailing Address - Phone:573-885-6000
Mailing Address - Fax:573-885-6002
Practice Address - Street 1:108 BUCHANAN
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453
Practice Address - Country:US
Practice Address - Phone:573-885-6000
Practice Address - Fax:573-885-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263846Medicare Oscar/Certification