Provider Demographics
NPI:1568978138
Name:WILLISTON PARKS AND RECREATION DEPT
Entity Type:Organization
Organization Name:WILLISTON PARKS AND RECREATION DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-774-9773
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1153
Mailing Address - Country:US
Mailing Address - Phone:701-774-9773
Mailing Address - Fax:
Practice Address - Street 1:822 18TH ST E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4475
Practice Address - Country:US
Practice Address - Phone:701-774-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty