Healthcare Provider Details

I. General information

NPI: 1376664086
Provider Name (Legal Business Name): STARK COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W BROADWAY
DICKINSON ND
58602-0629
US

IV. Provider business mailing address

PO BOX 629
DICKINSON ND
58602-0629
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-1818
  • Fax: 701-456-1820
Mailing address:
  • Phone: 701-456-1818
  • Fax: 701-456-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MIDGE KUNTZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-456-1818