Provider Demographics
NPI:1497984546
Name:BIG STONE COUNTY FAMILY SERVICES
Entity Type:Organization
Organization Name:BIG STONE COUNTY FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:VALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-839-2555
Mailing Address - Street 1:340 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1413
Mailing Address - Country:US
Mailing Address - Phone:320-839-2555
Mailing Address - Fax:320-839-3966
Practice Address - Street 1:340 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1413
Practice Address - Country:US
Practice Address - Phone:320-839-2555
Practice Address - Fax:320-839-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA000006000Medicaid