Provider Demographics
NPI:1689036865
Name:SCENIC BLUFFS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SCENIC BLUFFS HEALTH CENTER, INC.
Other - Org Name:SCENIC BLUFFS COMMUNITY HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARI
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FREIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-654-5100
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:CASHTON
Mailing Address - State:WI
Mailing Address - Zip Code:54619-0039
Mailing Address - Country:US
Mailing Address - Phone:608-654-5100
Mailing Address - Fax:608-654-5120
Practice Address - Street 1:201 E FRANKLIN ST RM B3
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-1803
Practice Address - Country:US
Practice Address - Phone:608-654-5100
Practice Address - Fax:608-654-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
521854Medicare Oscar/Certification