Healthcare Provider Details

I. General information

NPI: 1235559683
Provider Name (Legal Business Name): GRIGGS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 BURREL AVE SE
COOPERSTOWN ND
58425-0567
US

IV. Provider business mailing address

PO BOX 567 912 BURREL AVE SE
COOPERSTOWN ND
58425-0567
US

V. Phone/Fax

Practice location:
  • Phone: 701-797-2127
  • Fax: 701-797-2172
Mailing address:
  • Phone: 701-797-2127
  • Fax: 701-797-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3023
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number3023
License Number StateND

VIII. Authorized Official

Name: CIA GRONNEBERG
Title or Position: LSW/DIRECTOR
Credential: LSW
Phone: 701-797-2127