Provider Demographics
NPI:1124197249
Name:WRIGHT COUNTY
Entity Type:Organization
Organization Name:WRIGHT COUNTY
Other - Org Name:WRIGHT COUNTY HEALTH & HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-682-7411
Mailing Address - Street 1:3650 BRADDOCK AVE NE STE 2100
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-3675
Mailing Address - Country:US
Mailing Address - Phone:763-682-7400
Mailing Address - Fax:763-682-7701
Practice Address - Street 1:1004 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1736
Practice Address - Country:US
Practice Address - Phone:763-682-7400
Practice Address - Fax:763-682-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X
251B00000X, 251K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN000086800Medicaid