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General NPI Number Information
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NPI Number | 1720457401
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Entity Type | Organization
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Legal Business Name | INTER-COUNTY COMMUNITY COUNCIL
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 207 MAIN STREET
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City | OKLEE
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State | MN
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Zip | 56742
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Country | US
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Telephone | 218-796-5144
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Fax | 218-796-5175
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Provider Business Mailing Address
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Address Line | PO BOX 189 207 MAIN STREET
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City | OKLEE
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State | MN
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Zip | 56742
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Country | US
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Telephone | 218-796-5144
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Fax | 218-796-5175
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CATHERINE JOHNSON
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Credential |
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Telephone | 218-796-5144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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