Provider Demographics
NPI:1922073121
Name:HRC MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:HRC MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-392-8216
Mailing Address - Street 1:39 N 25TH ST E
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5269
Mailing Address - Country:US
Mailing Address - Phone:715-392-8216
Mailing Address - Fax:715-392-6055
Practice Address - Street 1:39 N 25TH ST E
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-5269
Practice Address - Country:US
Practice Address - Phone:715-392-8216
Practice Address - Fax:715-392-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
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
MN42109500Medicaid
MN42109500Medicaid