Provider Demographics
NPI:1225542988
Name:RURAL CASS SPECIAL SERVICES
Entity Type:Organization
Organization Name:RURAL CASS SPECIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-428-3177
Mailing Address - Street 1:255 DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:ND
Mailing Address - Zip Code:58051-4225
Mailing Address - Country:US
Mailing Address - Phone:701-428-3177
Mailing Address - Fax:
Practice Address - Street 1:55 1ST AVE S
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:ND
Practice Address - Zip Code:58051-4027
Practice Address - Country:US
Practice Address - Phone:701-428-3288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1159261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health