Provider Demographics
NPI:1447660261
Name:BOTTINEAU COUNTY SOCIAL SERVICES
Entity type:Organization
Organization Name:BOTTINEAU COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR II
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-228-3613
Mailing Address - Street 1:314 5TH ST W
Mailing Address - Street 2:STE 1
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1204
Mailing Address - Country:US
Mailing Address - Phone:701-228-3613
Mailing Address - Fax:701-228-3600
Practice Address - Street 1:314 5TH ST W
Practice Address - Street 2:STE 1
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1204
Practice Address - Country:US
Practice Address - Phone:701-228-3613
Practice Address - Fax:701-228-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00050715Medicaid