Provider Demographics
NPI:1861849978
Name:COUNTY OF PINE
Entity Type:Organization
Organization Name:COUNTY OF PINE
Other - Org Name:PINE COUNTY HEALTH AND HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PINE COUNTY HHS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-216-4104
Mailing Address - Street 1:635 NORTHRIDGE DR NW STE 220
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-5984
Mailing Address - Country:US
Mailing Address - Phone:320-591-1570
Mailing Address - Fax:320-591-1602
Practice Address - Street 1:635 NORTHRIDGE DR NW STE 220
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-5984
Practice Address - Country:US
Practice Address - Phone:320-591-1570
Practice Address - Fax:320-591-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251K00000X
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN908853900OtherMEDICARE, TYPE UNSPECIFIED
MNA000058200Medicaid