Provider Demographics
NPI:1134897663
Name:CAS PSYCHIATRIC SERVICES PA
Entity type:Organization
Organization Name:CAS PSYCHIATRIC SERVICES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PFMHNP
Authorized Official - Phone:218-751-0887
Mailing Address - Street 1:1526 30TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-4140
Mailing Address - Country:US
Mailing Address - Phone:218-751-0282
Mailing Address - Fax:218-759-4807
Practice Address - Street 1:1526 30TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4140
Practice Address - Country:US
Practice Address - Phone:218-751-0282
Practice Address - Fax:218-759-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty