Provider Demographics
NPI:1205064300
Name:RED LAKE COUNTY SOCIAL SERVICES
Entity type:Organization
Organization Name:RED LAKE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE AIDE
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLSTOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-253-4131
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:RED LAKE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56750-0356
Mailing Address - Country:US
Mailing Address - Phone:218-253-4131
Mailing Address - Fax:218-253-2926
Practice Address - Street 1:125 EDWARDS AVE SW
Practice Address - Street 2:
Practice Address - City:RED LAKE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56750-4019
Practice Address - Country:US
Practice Address - Phone:218-253-4131
Practice Address - Fax:218-253-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management