Provider Demographics
NPI:1912970849
Name:COOK AREA HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:COOK AREA HEALTH SERVICES, INC
Other - Org Name:SCENIC RIVERS HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-666-5941
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:12052 MAIN ST
Mailing Address - City:NORTHOME
Mailing Address - State:MN
Mailing Address - Zip Code:56661-0066
Mailing Address - Country:US
Mailing Address - Phone:218-897-5222
Mailing Address - Fax:218-897-5226
Practice Address - Street 1:12052 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHOME
Practice Address - State:MN
Practice Address - Zip Code:56661-0066
Practice Address - Country:US
Practice Address - Phone:218-897-5222
Practice Address - Fax:218-897-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A261Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN216354300Medicaid
MN24-1812Medicare PIN
MNC06888Medicare PIN