Provider Demographics
NPI:1396819108
Name:KANABEC COUNTY FAMILY SERVICES
Entity Type:Organization
Organization Name:KANABEC COUNTY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-679-6352
Mailing Address - Street 1:905 FOREST AVE E
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1624
Mailing Address - Country:US
Mailing Address - Phone:320-679-6350
Mailing Address - Fax:
Practice Address - Street 1:905 FOREST AVE E
Practice Address - Street 2:SUITE 150
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1624
Practice Address - Country:US
Practice Address - Phone:320-679-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN000033700Medicaid