Provider Demographics
NPI:1841988433
Name:SPRING RIVER MENTAL HEALTH & WELLNESS, INC.
Entity type:Organization
Organization Name:SPRING RIVER MENTAL HEALTH & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-848-2300
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66770-0550
Mailing Address - Country:US
Mailing Address - Phone:620-848-2300
Mailing Address - Fax:620-848-2304
Practice Address - Street 1:6610 SE QUAKERVALE RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:KS
Practice Address - Zip Code:66770-4185
Practice Address - Country:US
Practice Address - Phone:620-848-2300
Practice Address - Fax:620-848-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003922010007Medicaid
KS30003922010002Medicaid