Provider Demographics
NPI:1710228291
Name:MID-PLAINS CENTER FOR BEHAVIORAL HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:MID-PLAINS CENTER FOR BEHAVIORAL HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYDALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-395-1067
Mailing Address - Street 1:PO BOX 1763
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 BAUMANN DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4401
Practice Address - Country:US
Practice Address - Phone:308-385-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QM0801X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE261QM0801XMedicaid