Provider Demographics
NPI:1851702914
Name:GRAND FORKS COUNTY SOCIAL SERVICES
Entity type:Organization
Organization Name:GRAND FORKS COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-787-8519
Mailing Address - Street 1:PO BOX 5196
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-5196
Mailing Address - Country:US
Mailing Address - Phone:701-787-8540
Mailing Address - Fax:701-787-5918
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-787-8540
Practice Address - Fax:701-787-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND000050728171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000050728Medicaid