Healthcare Provider Details

I. General information

NPI: 1831215128
Provider Name (Legal Business Name): OTTER TAIL WADENA COMMUNITY ACTION COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST AVE S
PERHAM MN
56573-1445
US

IV. Provider business mailing address

PO BOX L
NEW YORK MILLS MN
56567-0372
US

V. Phone/Fax

Practice location:
  • Phone: 218-346-3612
  • Fax: 218-346-3612
Mailing address:
  • Phone: 218-385-2900
  • Fax: 218-385-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVIS LEINO-MILLS
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 218-385-2900