Provider Demographics
NPI:1467874149
Name:ADAMS COUNTY SOCIAL SERVICE BOARD
Entity Type:Organization
Organization Name:ADAMS COUNTY SOCIAL SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIX
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-567-2967
Mailing Address - Street 1:609 2ND AVE N
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7449
Mailing Address - Country:US
Mailing Address - Phone:701-567-2967
Mailing Address - Fax:701-567-2498
Practice Address - Street 1:609 2ND AVE N
Practice Address - Street 2:
Practice Address - City:HETTINGER
Practice Address - State:ND
Practice Address - Zip Code:58639-7449
Practice Address - Country:US
Practice Address - Phone:701-567-2967
Practice Address - Fax:701-567-2498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ADAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0000000000000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000038801Medicaid
ND000050711Medicaid