Healthcare Provider Details

I. General information

NPI: 1033522792
Provider Name (Legal Business Name): DIVIDE COUNTY SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH MAIN STREET
CROSBY ND
58730-0009
US

IV. Provider business mailing address

PO BOX 9
CROSBY ND
58730-0009
US

V. Phone/Fax

Practice location:
  • Phone: 701-965-6521
  • Fax: 701-965-6529
Mailing address:
  • Phone: 701-965-6521
  • Fax: 701-965-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA PULVERMACHER
Title or Position: COUNTY DIRECTOR
Credential:
Phone: 701-965-6521