Provider Demographics
NPI:1285910596
Name:MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Entity type:Organization
Organization Name:MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUOPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-847-1385
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0747
Mailing Address - Country:US
Mailing Address - Phone:218-847-1385
Mailing Address - Fax:218-847-1388
Practice Address - Street 1:1125 W RIVER RD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2722
Practice Address - Country:US
Practice Address - Phone:218-847-1385
Practice Address - Fax:218-847-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA246932400253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care