Provider Demographics
NPI:1508374901
Name:BURKE COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:BURKE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-377-2313
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BOWBELLS
Mailing Address - State:ND
Mailing Address - Zip Code:58721-0220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN STREET SE
Practice Address - Street 2:
Practice Address - City:BOWBELLS
Practice Address - State:ND
Practice Address - Zip Code:58721
Practice Address - Country:US
Practice Address - Phone:701-377-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management