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General NPI Number Information
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NPI Number | 1104827500
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Entity Type | Organization
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Legal Business Name | MILLE LACS COUNTY
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 525 2ND ST SE
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City | MILACA
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State | MN
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Zip | 56353-1303
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Country | US
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Telephone | 320-983-8208
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Fax | 320-983-8306
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Provider Business Mailing Address
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Address Line | 525 2ND ST SE
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City | MILACA
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State | MN
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Zip | 56353-1303
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Country | US
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Telephone | 320-983-8318
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Fax | 320-983-8353
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Authorized Official
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Title or Position | MLC CVS DIRECTOR
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Name | MS. CHAR KOHLGRAF
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Credential |
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Telephone | 320-983-8208
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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 | 548753600
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License Number State | MN
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