Provider Demographics
NPI:1376612820
Name:HUMAN SERVICES OF FARIBAULT & MARTIN COUNTIES
Entity Type:Organization
Organization Name:HUMAN SERVICES OF FARIBAULT & MARTIN COUNTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUS MGMT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-238-4757
Mailing Address - Street 1:115 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-1717
Mailing Address - Country:US
Mailing Address - Phone:507-238-4757
Mailing Address - Fax:507-238-1485
Practice Address - Street 1:115 W 1ST ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-1717
Practice Address - Country:US
Practice Address - Phone:507-238-4757
Practice Address - Fax:507-238-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8G634HUMedicare UPIN
MN160858Medicare UPIN
MN156R3DSMedicare UPIN
MN2028CHUMedicare UPIN
MN116015Medicare UPIN
MN160857Medicare UPIN
MN7G523HUMedicare UPIN