Healthcare Provider Details

I. General information

NPI: 1588939276
Provider Name (Legal Business Name): MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GRAYSTONE PLZ STE 110
DETROIT LAKES MN
56501-3034
US

IV. Provider business mailing address

1125 W RIVER RD
DETROIT LAKES MN
56501-2722
US

V. Phone/Fax

Practice location:
  • Phone: 218-847-1385
  • Fax: 218-847-1388
Mailing address:
  • Phone: 218-847-1385
  • Fax: 218-847-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateMN

VIII. Authorized Official

Name: ELIZABETH KUOPPALA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 218-847-1385