Provider Demographics
NPI:1477684041
Name:KITTSON COUNTY
Entity Type:Organization
Organization Name:KITTSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HIPAA COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:218-843-2113
Mailing Address - Street 1:410 S. 5TH ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56735-0104
Mailing Address - Country:US
Mailing Address - Phone:218-843-2113
Mailing Address - Fax:218-843-2020
Practice Address - Street 1:410 S 5TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HALLOCK
Practice Address - State:MN
Practice Address - Zip Code:56728-4140
Practice Address - Country:US
Practice Address - Phone:218-843-2113
Practice Address - Fax:218-843-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN123189OtherUCARE MINNESOTA
MN123189OtherUCARE MINNESOTA