Provider Demographics
NPI:1164651204
Name:DES MOINES VALLEY HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:DES MOINES VALLEY HEALTH AND HUMAN SERVICES
Other - Org Name:COUNTY OF COTTONWOOD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIR OF BUSINESS OPER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-831-1891
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-9998
Mailing Address - Country:US
Mailing Address - Phone:507-831-1891
Mailing Address - Fax:507-831-0126
Practice Address - Street 1:11 4TH ST
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-9998
Practice Address - Country:US
Practice Address - Phone:507-831-1891
Practice Address - Fax:507-831-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA000017500Medicaid
MN000017500Medicaid
MNA000017500OtherUMPI