Healthcare Provider Details

I. General information

NPI: 1164512372
Provider Name (Legal Business Name): BECKER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 MINNESOTA AVE
DETROIT LAKES MN
56501-3035
US

IV. Provider business mailing address

712 MINNESOTA AVE
DETROIT LAKES MN
56501-3035
US

V. Phone/Fax

Practice location:
  • Phone: 218-847-5628
  • Fax: 218-847-6738
Mailing address:
  • Phone: 218-847-5628
  • Fax: 218-847-6738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number163WC1500X
License Number StateMN

VIII. Authorized Official

Name: NANCY NELSON
Title or Position: DIRECTOR
Credential:
Phone: 218-847-5628