Healthcare Provider Details

I. General information

NPI: 1376612820
Provider Name (Legal Business Name): HUMAN SERVICES OF FARIBAULT & MARTIN COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 1ST ST
FAIRMONT MN
56031-1717
US

IV. Provider business mailing address

115 W 1ST ST
FAIRMONT MN
56031-1717
US

V. Phone/Fax

Practice location:
  • Phone: 507-238-4757
  • Fax: 507-238-1485
Mailing address:
  • Phone: 507-238-4757
  • Fax: 507-238-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHY S WERNER
Title or Position: DIRECTOR OF BUS MGMT
Credential:
Phone: 507-238-4757