MEDICARE: BECKER COUNTY HUMAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1518284272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKER COUNTY HUMAN SERVICES

Provider Business Mailing Address
First Line	:	712 MINNESOTA AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3035
Country	:	US
Telephone Number	:
Fax Number	:	218-847-6738

Provider Business Practice Location Address
First Line	:	712 MINNESOTA AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-3035
Country	:	US
Telephone Number	:	218-847-5628
Fax Number	:	218-847-6738

Authorized Official
Title or Position	:	HUMAN SERVICES DIRECTOR
Name	:	NANCY NELSON
Credential	:
Telephone Number	:	218-847-5628

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/21/2010

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