Provider Demographics
NPI:1619064946
Name:RICHLAND COUNTY
Entity Type:Organization
Organization Name:RICHLAND COUNTY
Other - Org Name:RICHLAND COUNTY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN MS
Authorized Official - Phone:701-642-7735
Mailing Address - Street 1:413 3RD AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075
Mailing Address - Country:US
Mailing Address - Phone:701-642-7735
Mailing Address - Fax:701-642-7746
Practice Address - Street 1:413 3RD AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075
Practice Address - Country:US
Practice Address - Phone:701-642-7735
Practice Address - Fax:701-642-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4032A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND414OtherBCBS ND
ND50080Medicaid
357004Medicare ID - Type Unspecified