Provider Demographics
NPI:1548597917
Name:REGION 4 SOUTH ADULT MENTAL HEALTH CONSORTIUM
Entity Type:Organization
Organization Name:REGION 4 SOUTH ADULT MENTAL HEALTH CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MURLAINE
Authorized Official - Last Name:PESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-685-8229
Mailing Address - Street 1:32 CENTRAL AVE S
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ELBOW LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56531-4100
Mailing Address - Country:US
Mailing Address - Phone:218-685-8229
Mailing Address - Fax:218-685-6414
Practice Address - Street 1:32 CENTRAL AVE S
Practice Address - Street 2:SUITE 7
Practice Address - City:ELBOW LAKE
Practice Address - State:MN
Practice Address - Zip Code:56531-4100
Practice Address - Country:US
Practice Address - Phone:218-685-8229
Practice Address - Fax:218-685-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health