Provider Demographics
NPI:1487830808
Name:UPPER SIOUX COMMUNITY SOCIAL SERVICES
Entity Type:Organization
Organization Name:UPPER SIOUX COMMUNITY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:HIEDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-564-6318
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-0147
Mailing Address - Country:US
Mailing Address - Phone:320-564-2360
Mailing Address - Fax:320-564-2550
Practice Address - Street 1:5744 HWY 67 EAST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-0147
Practice Address - Country:US
Practice Address - Phone:320-564-6318
Practice Address - Fax:320-564-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management