Provider Demographics
NPI:1194113597
Name:KIDDER COUNTY SOCIAL SERVICE BOARD
Entity type:Organization
Organization Name:KIDDER COUNTY SOCIAL SERVICE BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-475-2551
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:STEELE
Mailing Address - State:ND
Mailing Address - Zip Code:58482-0036
Mailing Address - Country:US
Mailing Address - Phone:701-475-2551
Mailing Address - Fax:701-475-2197
Practice Address - Street 1:120 E BROADWAY
Practice Address - Street 2:
Practice Address - City:STEELE
Practice Address - State:ND
Practice Address - Zip Code:58482-7111
Practice Address - Country:US
Practice Address - Phone:701-475-2551
Practice Address - Fax:701-475-2197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDDER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND00000251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000050732Medicaid