Provider Demographics
NPI:1023288396
Name:SOUTH CENTRAL BEHAVIORAL SERVICES, INC
Entity type:Organization
Organization Name:SOUTH CENTRAL BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:308-237-5951
Mailing Address - Street 1:3810 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8134
Mailing Address - Country:US
Mailing Address - Phone:308-237-5951
Mailing Address - Fax:
Practice Address - Street 1:255 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-2018
Practice Address - Country:US
Practice Address - Phone:308-872-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE80873595261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========27Medicaid