Provider Demographics
NPI:1649594425
Name:PENNINGTON COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:PENNINGTON COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YUTRZENKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-681-2880
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-0340
Mailing Address - Country:US
Mailing Address - Phone:218-681-2880
Mailing Address - Fax:218-683-7013
Practice Address - Street 1:318 KNIGHT AVE N
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-1929
Practice Address - Country:US
Practice Address - Phone:218-681-2880
Practice Address - Fax:218-683-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management