Provider Demographics
NPI:1194736553
Name:COUNTY OF CROW WING
Entity type:Organization
Organization Name:COUNTY OF CROW WING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-824-1205
Mailing Address - Street 1:204 LAUREL ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3547
Mailing Address - Country:US
Mailing Address - Phone:218-824-1080
Mailing Address - Fax:218-824-1081
Practice Address - Street 1:204 LAUREL ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3547
Practice Address - Country:US
Practice Address - Phone:218-824-1080
Practice Address - Fax:218-824-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN369857251E00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1194736553Medicaid
MN117302OtherHEALTH PARTNERS
MN151083OtherUCARE OF MINNESOTA
MN8234CROtherBCBS OF MN
MN83-02317OtherMEDICA
MN8G848CROtherBCBS / BLUE PLUS OF MN
MN117302OtherHEALTH PARTNERS