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General NPI Number Information
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NPI Number | 1851497309
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Entity Type | Organization
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Legal Business Name | COUNTY OF ISANTI
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 555 18TH AVE SW
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City | CAMBRIDGE
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State | MN
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Zip | 55008
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Country | US
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Telephone | 763-689-4071
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Fax | 763-689-8293
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Provider Business Mailing Address
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Address Line | 555 18TH AVE SW
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City | CAMBRIDGE
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State | MN
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Zip | 55008
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Country | US
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Telephone | 763-689-4071
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Fax | 763-689-8293
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Authorized Official
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Title or Position | CHS ADMINISTRATOR/ DIRECTOR
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Name | MR. ANTHONY GLENN BUTTACAVOLI
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Credential |
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Telephone | 763-689-8284
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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 | MN
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