Provider Demographics
NPI:1407148323
Name:CIRRUS HOUSE, INC.
Entity Type:Organization
Organization Name:CIRRUS HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:LUANN
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:308-635-2256
Mailing Address - Street 1:1509 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3106
Mailing Address - Country:US
Mailing Address - Phone:308-635-1488
Mailing Address - Fax:308-635-1271
Practice Address - Street 1:1509 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3106
Practice Address - Country:US
Practice Address - Phone:308-635-1488
Practice Address - Fax:308-635-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-80Medicaid