Healthcare Provider Details

I. General information

NPI: 1134773864
Provider Name (Legal Business Name): SCENIC BLUFFS HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W ADAMS ST
LA FARGE WI
54639-7936
US

IV. Provider business mailing address

PO BOX 39
CASHTON WI
54619-0039
US

V. Phone/Fax

Practice location:
  • Phone: 608-654-5100
  • Fax:
Mailing address:
  • Phone: 608-654-5100
  • Fax: 608-654-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KIM HAWTHORNE
Title or Position: CEO
Credential:
Phone: 608-654-5100