Provider Demographics
NPI:1881008266
Name:ROLETTE COUNTY SOCIAL SERVICES
Entity Type:Organization
Organization Name:ROLETTE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL SERVICE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHIASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-3141
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0802
Mailing Address - Country:US
Mailing Address - Phone:701-477-3141
Mailing Address - Fax:701-477-5979
Practice Address - Street 1:210 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367
Practice Address - Country:US
Practice Address - Phone:701-477-3141
Practice Address - Fax:701-477-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND50750251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management