Provider Demographics
NPI:1659354512
Name:DOUGLAS COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:DOUGLAS COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-762-2302
Mailing Address - Street 1:809 ELM ST
Mailing Address - Street 2:SUITE 1186
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1772
Mailing Address - Country:US
Mailing Address - Phone:320-762-2302
Mailing Address - Fax:320-762-3833
Practice Address - Street 1:809 ELM ST
Practice Address - Street 2:SUITE 1186
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1772
Practice Address - Country:US
Practice Address - Phone:320-762-2302
Practice Address - Fax:320-762-3833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-23
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
156RIDSOtherBLUE CROSS BLUE SHIELD
MN0000213Medicaid
030726032OtherPRIMEWEST HEALTH SYSTEMS
2052HDOOtherBLUE CROSS BLUE SHIELD