Provider Demographics
NPI:1588939276
Name:MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Entity type:Organization
Organization Name:MAHUBE-OTWA COMMUNITY ACTION PARTNERSHIP
Other - Org Name:<UNAVAIL>
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 2:1125 WEST RIVER ROAD
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 1:119 GRAYSTONE PLZ STE 110
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3034
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:2012-03-14
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical