Provider Demographics
NPI:1386880599
Name:AITKIN-ITASCA-KOOCHICHING CHB
Entity type:Organization
Organization Name:AITKIN-ITASCA-KOOCHICHING CHB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRANTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:FUSS
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-5525
Mailing Address - Street 1:1209 SE 2ND AVE
Mailing Address - Street 2:ITASCA RESOURCE CENTER
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3982
Mailing Address - Country:US
Mailing Address - Phone:218-327-5525
Mailing Address - Fax:218-327-5546
Practice Address - Street 1:1209 SE 2ND AVE
Practice Address - Street 2:ITASCA RESOURCE CENTER
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3982
Practice Address - Country:US
Practice Address - Phone:218-327-5525
Practice Address - Fax:218-327-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare