Provider Demographics
NPI:1851782114
Name:MCINTOSH COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:MCINTOSH COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-288-3343
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58413-0218
Mailing Address - Country:US
Mailing Address - Phone:701-288-3343
Mailing Address - Fax:701-288-2186
Practice Address - Street 1:112 1ST ST NE
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:ND
Practice Address - Zip Code:58413
Practice Address - Country:US
Practice Address - Phone:701-288-3343
Practice Address - Fax:701-288-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50736Medicaid