Provider Demographics
NPI:1427392455
Name:POLK-NORMAN-MAHNOMEN COMMUNITY HEALTH BOARD
Entity Type:Organization
Organization Name:POLK-NORMAN-MAHNOMEN COMMUNITY HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER-REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CHES
Authorized Official - Phone:218-281-3385
Mailing Address - Street 1:816 MARIN AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-2148
Mailing Address - Country:US
Mailing Address - Phone:218-281-3385
Mailing Address - Fax:218-281-7376
Practice Address - Street 1:816 MARIN AVE STE 125
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2148
Practice Address - Country:US
Practice Address - Phone:218-281-3385
Practice Address - Fax:218-281-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare