Provider Demographics
NPI:1114142569
Name:CLAY COUNTY
Entity Type:Organization
Organization Name:CLAY COUNTY
Other - Org Name:CLAY COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLAY COUNTY AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-299-5262
Mailing Address - Street 1:715 11TH ST N STE 303
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2083
Mailing Address - Country:US
Mailing Address - Phone:218-299-7301
Mailing Address - Fax:218-299-5195
Practice Address - Street 1:715 11TH ST N
Practice Address - Street 2:STE 303
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2083
Practice Address - Country:US
Practice Address - Phone:218-299-7301
Practice Address - Fax:218-299-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8300104OtherMEDICA PMAP PROVIDER
MN427753800Medicaid
MN5060753OtherMEDICA UBH PROVIDER
MN4C45CLOtherBLUE PLUS DETOX PROVIDER
MN8G510CLOtherBLUE PLUS PROVIDER ID
MN427753800Medicaid