Healthcare Provider Details

I. General information

NPI: 1689677478
Provider Name (Legal Business Name): COUNTY OF DOUGLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ELM ST STE 1200
ALEXANDRIA MN
56308-1760
US

IV. Provider business mailing address

725 ELM ST STE 1200
ALEXANDRIA MN
56308-1760
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-6018
  • Fax: 320-763-4127
Mailing address:
  • Phone: 320-763-6018
  • Fax: 320-763-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number326907
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMN

VIII. Authorized Official

Name: MS. SANDRA L TUBBS
Title or Position: DIRECTOR
Credential: PHN
Phone: 320-763-6018