Provider Demographics
NPI:1881703486
Name:COUNTY OF CLEARWATER
Entity type:Organization
Organization Name:COUNTY OF CLEARWATER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-694-6581
Mailing Address - Street 1:212 MAIN AVE N
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8313
Mailing Address - Country:US
Mailing Address - Phone:218-694-6581
Mailing Address - Fax:218-694-6594
Practice Address - Street 1:212 MAIN AVE N
Practice Address - Street 2:
Practice Address - City:BAGLEY
Practice Address - State:MN
Practice Address - Zip Code:56621-8313
Practice Address - Country:US
Practice Address - Phone:218-694-6581
Practice Address - Fax:218-694-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330351251E00000X
MN333488251G00000X
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5900209OtherHOME HEALTH
MN8300122OtherPUBLIC HEALTH
MN8233CLOtherHOME HEALTH
MN8G491CLOtherPUBLIC HEALTH
MN8G491CLOtherPUBLIC HEALTH
MN241577Medicare ID - Type UnspecifiedHOSPICE