=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518050228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CHISAGO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 09/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6133 402ND ST
-----------------------------------------------------
City | NORTH BRANCH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55056-6097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-213-5231
-----------------------------------------------------
Fax | 651-213-5401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 N MAIN STREET RM 240
-----------------------------------------------------
City | CENTER CITY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-213-5639
-----------------------------------------------------
Fax | 651-213-5685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PUBLIC HEALTH
-----------------------------------------------------
Name | JILL A BRIGGS
-----------------------------------------------------
Credential | PHN
-----------------------------------------------------
Telephone | 651-213-5231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------