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General NPI Number Information
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NPI Number | 1104098672
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Entity Type | Organization
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Legal Business Name | TRI-VALLEY OPPORTUNITY COUNCIL
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 102 N BROADWAY
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City | CROOKSTON
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State | MN
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Zip | 56716-1731
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Country | US
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Telephone | 218-281-5832
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Fax | 218-281-6676
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | CROOKSTON
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State | MN
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Zip | 56716-0607
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Country | US
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Telephone | 218-281-5832
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Fax | 218-281-6676
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Authorized Official
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Title or Position | HEALTH SERVICES MANAGER
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Name | CYNTHIA E BOUDREAUX
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Credential | RN
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Telephone | 218-281-5832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | R137745-7
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License Number State | MN
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