Healthcare Provider Details

I. General information

NPI: 1174700611
Provider Name (Legal Business Name): COUNTRY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16995 ENFIELD PATH
LAKEVILLE MN
55044-4769
US

IV. Provider business mailing address

16995 ENFIELD PATH
LAKEVILLE MN
55044-4769
US

V. Phone/Fax

Practice location:
  • Phone: 651-270-5903
  • Fax:
Mailing address:
  • Phone: 651-270-5903
  • Fax: 651-998-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA JEAN GOELDNER
Title or Position: CEO
Credential: LSW
Phone: 651-270-5903