Provider Demographics
NPI:1619399334
Name:STUTSMAN COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:STUTSMAN COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENDEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-952-6812
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58402-0809
Mailing Address - Country:US
Mailing Address - Phone:701-952-6850
Mailing Address - Fax:701-252-1561
Practice Address - Street 1:116 1ST STREET EAST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-952-6850
Practice Address - Fax:701-252-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND50757171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50757Medicaid