Provider Demographics
NPI:1164512372
Name:BECKER COUNTY
Entity Type:Organization
Organization Name:BECKER COUNTY
Other - Org Name:BECKER COUNTY COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-847-5628
Mailing Address - Street 1:712 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3035
Mailing Address - Country:US
Mailing Address - Phone:218-847-5628
Mailing Address - Fax:218-847-6738
Practice Address - Street 1:712 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3035
Practice Address - Country:US
Practice Address - Phone:218-847-5628
Practice Address - Fax:218-847-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163WC1500X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN338K8BEOtherBLUE PLUS
MN83-00119OtherMEDICA
MN084915400Medicaid
MN59-00258OtherMEDICA
MN084915400Medicaid