MEDICARE: CENTENNIAL MENTAL HEALTH CENTER, INC.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

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	:	1548865017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTENNIAL MENTAL HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	211 W MAIN ST
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-3168
Country	:	US
Telephone Number	:	970-522-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W KIOWA AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-2368
Country	:	US
Telephone Number	:	970-466-0639
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	SHERRI DAVIDSON
Credential	:
Telephone Number	:	970-522-4549

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	07/15/2021

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