Healthcare Provider Details

I. General information

NPI: 1295243277
Provider Name (Legal Business Name): RENVILLE COUNTY SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MAIN ST E
MOHALL ND
58761-4014
US

IV. Provider business mailing address

PO BOX 305
MOHALL ND
58761-0305
US

V. Phone/Fax

Practice location:
  • Phone: 701-756-6374
  • Fax: 701-756-6618
Mailing address:
  • Phone: 701-756-6374
  • Fax: 701-756-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WALLACE
Title or Position: DIRECTOR
Credential:
Phone: 701-756-6374