Provider Demographics
NPI:1578014486
Name:COUNTY OF KANABEC
Entity Type:Organization
Organization Name:COUNTY OF KANABEC
Other - Org Name:KANABEC COUNTY COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-679-6438
Mailing Address - Street 1:905 FOREST AVE E
Mailing Address - Street 2:SUITE 127
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1624
Mailing Address - Country:US
Mailing Address - Phone:320-679-6330
Mailing Address - Fax:320-679-6333
Practice Address - Street 1:905 FOREST AVE E
Practice Address - Street 2:SUITE 127
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1624
Practice Address - Country:US
Practice Address - Phone:320-679-6330
Practice Address - Fax:320-679-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375389251K00000X
MN380507251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN471555100Medicaid
MN471555100Medicaid