Provider Demographics
NPI:1437364908
Name:NORMAN-MAHNOMEN COMMUNITY HEALTH BOARD
Entity Type:Organization
Organization Name:NORMAN-MAHNOMEN COMMUNITY HEALTH BOARD
Other - Org Name:NORMAN-MAHNOMEN PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KJONO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHN
Authorized Official - Phone:218-784-5425
Mailing Address - Street 1:15 2ND AVE E
Mailing Address - Street 2:RM 107
Mailing Address - City:ADA
Mailing Address - State:MN
Mailing Address - Zip Code:56510-1312
Mailing Address - Country:US
Mailing Address - Phone:218-784-5425
Mailing Address - Fax:218-784-7818
Practice Address - Street 1:15 2ND AVE E
Practice Address - Street 2:RM 107
Practice Address - City:ADA
Practice Address - State:MN
Practice Address - Zip Code:56510-1312
Practice Address - Country:US
Practice Address - Phone:218-784-5425
Practice Address - Fax:218-784-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN936853100Medicaid