Healthcare Provider Details

I. General information

NPI: 1750588976
Provider Name (Legal Business Name): TRI-COUNTY COMMUNITY ACTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 LEMIEUR ST
LITTLE FALLS MN
56345-3367
US

IV. Provider business mailing address

501 LEMIEUR ST
LITTLE FALLS MN
56345-3367
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-3691
  • Fax: 320-632-3695
Mailing address:
  • Phone: 320-632-3691
  • Fax: 320-632-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY O. KETCHUM
Title or Position: DIRECTOR OF OPERATIONS
Credential: MSW
Phone: 320-632-3691