Provider Demographics
NPI:1033522792
Name:DIVIDE COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:DIVIDE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULVERMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-965-6521
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:ND
Mailing Address - Zip Code:58730-0009
Mailing Address - Country:US
Mailing Address - Phone:701-965-6521
Mailing Address - Fax:701-965-6529
Practice Address - Street 1:200 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:ND
Practice Address - Zip Code:58730-0009
Practice Address - Country:US
Practice Address - Phone:701-965-6521
Practice Address - Fax:701-965-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253J00000XAgenciesFoster Care AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND38812Medicaid
ND50722Medicaid