Provider Demographics
NPI:1962592196
Name:COUNTY OF HOLT
Entity type:Organization
Organization Name:COUNTY OF HOLT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN ADMINISTRATOR
Authorized Official - Phone:660-446-2909
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:MO
Mailing Address - Zip Code:64473-0438
Mailing Address - Country:US
Mailing Address - Phone:660-446-2909
Mailing Address - Fax:660-446-2921
Practice Address - Street 1:108 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:MO
Practice Address - Zip Code:64473-0438
Practice Address - Country:US
Practice Address - Phone:660-446-2909
Practice Address - Fax:660-446-2921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF HOLT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO513709006Medicaid
MO513709006Medicaid