MEDICARE: COLEGROVE COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	2761	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184824260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEGROVE COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	1354 27TH AVE STE 109
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1354 27TH AVE STE 109
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4961
Country	:	US
Telephone Number	:	402-562-6767
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL COLEGROVE
Credential	:
Telephone Number	:	402-562-6767

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	02/01/2008

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