Healthcare Provider Details

I. General information

NPI: 1053436220
Provider Name (Legal Business Name): KIOWA COUNTY DEPT OF SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 MAINE ST.
EADS CO
81036
US

IV. Provider business mailing address

1307 MAINE STREET
EADS CO
81036
US

V. Phone/Fax

Practice location:
  • Phone: 719-438-5541
  • Fax: 719-438-5370
Mailing address:
  • Phone: 719-439-5541
  • Fax: 719-438-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number06200315
License Number StateCO

VIII. Authorized Official

Name: MRS. NOVELLA KAY BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-438-5541