Provider Demographics
NPI:1649558495
Name:COUNTY OF CARLTON
Entity Type:Organization
Organization Name:COUNTY OF CARLTON
Other - Org Name:CARLTON COUNTY HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-879-4511
Mailing Address - Street 1:14 N 11TH ST
Mailing Address - Street 2:PO BOX 660
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1607
Mailing Address - Country:US
Mailing Address - Phone:218-879-4583
Mailing Address - Fax:218-879-2500
Practice Address - Street 1:14 N 11TH ST
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1607
Practice Address - Country:US
Practice Address - Phone:218-879-4583
Practice Address - Fax:218-879-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347B00000XTransportation ServicesBus
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9039916OtherMN TAX ID#
MN000009400Medicaid