Provider Demographics
NPI:1598177156
Name:MCKENZIE COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:MCKENZIE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-444-3661
Mailing Address - Street 1:201 5TH ST NW UNIT 790
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-7118
Mailing Address - Country:US
Mailing Address - Phone:701-444-3661
Mailing Address - Fax:701-444-6436
Practice Address - Street 1:201 5TH ST NW UNIT 790
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7118
Practice Address - Country:US
Practice Address - Phone:701-444-3661
Practice Address - Fax:701-444-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50737Medicaid