Healthcare Provider Details

I. General information

NPI: 1568686467
Provider Name (Legal Business Name): GRANT COUNTY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CENTRAL SOUTH
ELBOW LAKE MN
56531-1006
US

IV. Provider business mailing address

PO BOX 1006
ELBOW LAKE MN
56531-1006
US

V. Phone/Fax

Practice location:
  • Phone: 218-685-8200
  • Fax: 218-685-4978
Mailing address:
  • Phone: 218-685-8200
  • Fax: 218-685-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: JULIE A. CARLSON
Title or Position: FINANCIAL SUPERVISOR
Credential:
Phone: 218-685-8216