Basic Information
| Provider Information | |||||||||
| NPI: | 1841281805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERT NASH COMMUNITY MENTAL HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MAINE ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
| FaxNumber: | 7858436744 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MAINE ST | ||||||||
| Address2: | STE A | ||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858439192 | ||||||||
| FaxNumber: | 7858436744 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | FINKELDEI | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | SUTTON | ||||||||
| AuthorizedOfficialTitleorPosition: | DIR OF PERFORMANCE & QUALITY IMPROV | ||||||||
| AuthorizedOfficialTelephone: | 7858301796 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | CG6599 | 01 | KS | RAILROAD MEDICARE | OTHER | 100097940A | 05 | KS | MEDICAID |