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General NPI Number Information
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NPI Number | 1649403643
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Entity Type | Organization
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Legal Business Name | POLK COUNTY SOCIAL SERVICES
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | 612 N BROADWAY STE 110
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City | CROOKSTON
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State | MN
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Zip | 56716-1452
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Country | US
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Telephone | 218-281-3127
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Fax |
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Provider Business Mailing Address
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Address Line | 612 N BROADWAY STE 110
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City | CROOKSTON
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State | MN
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Zip | 56716-1452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. KENT JOHNSON
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Credential |
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Telephone | 218-470-8405
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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