Provider Demographics
NPI:1770761991
Name:CITY OF HAZEN
Entity type:Organization
Organization Name:CITY OF HAZEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOHRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-748-2550
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-0717
Mailing Address - Country:US
Mailing Address - Phone:701-748-2550
Mailing Address - Fax:701-748-2559
Practice Address - Street 1:146 EAST MAIN
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-0717
Practice Address - Country:US
Practice Address - Phone:701-748-2550
Practice Address - Fax:701-748-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND056000Medicaid