Provider Demographics
NPI:1831595487
Name:CAVALIER COUNTY SENIOR MEALS & SERVICES
Entity type:Organization
Organization Name:CAVALIER COUNTY SENIOR MEALS & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MIKKELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-256-2828
Mailing Address - Street 1:211 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2637
Mailing Address - Country:US
Mailing Address - Phone:701-256-2828
Mailing Address - Fax:701-256-2838
Practice Address - Street 1:211 8TH AVE
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2637
Practice Address - Country:US
Practice Address - Phone:701-256-2828
Practice Address - Fax:701-256-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDKDJ239347B00000X
NDG11306347B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND53954Medicaid