Provider Demographics
NPI:1962652958
Name:SOUTH CENTRAL BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:SOUTH CENTRAL BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORD
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-237-5951
Mailing Address - Street 1:3800 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847
Mailing Address - Country:US
Mailing Address - Phone:308-237-5951
Mailing Address - Fax:308-234-4018
Practice Address - Street 1:4111 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2883
Practice Address - Country:US
Practice Address - Phone:308-698-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL BEHAVIORAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-25
Last Update Date:2014-03-04
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
NE100256716-00Medicaid