MEDICARE: GRANT COUNTY SOCIAL SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1326439480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANT COUNTY SOCIAL SERVICE

Provider Business Mailing Address
First Line	:	106 2ND AVE. NE
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529-0278
Country	:	US
Telephone Number	:	701-622-3706
Fax Number	:	701-622-3045

Provider Business Practice Location Address
First Line	:	106 2ND AVE NORTH EAST
Second Line	:
City	:	CARSON
State	:	ND
Zip	:	58529
Country	:	US
Telephone Number	:	701-622-3706
Fax Number	:	701-622-3045

Authorized Official
Title or Position	:	DIRECTOR/SOCIAL WORKER
Name	:	MR. DOUG J WEGH
Credential	:
Telephone Number	:	701-622-3706

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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Directions to “GRANT COUNTY SOCIAL SERVICE ” Practice Location

Language	Start Address	Practice Location

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