Healthcare Provider Details

I. General information

NPI: 1477684041
Provider Name (Legal Business Name): KITTSON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S 5TH ST SUITE 104
HALLOCK MN
56728-4140
US

IV. Provider business mailing address

410 S. 5TH ST. SUITE 104
HALLOCK MN
56735-0104
US

V. Phone/Fax

Practice location:
  • Phone: 218-843-2113
  • Fax: 218-843-2020
Mailing address:
  • Phone: 218-843-2113
  • Fax: 218-843-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY LEE RICE I
Title or Position: HIPAA COORDINATOR
Credential:
Phone: 218-843-2113