Provider Demographics
NPI:1962721175
Name:DAKOTA COUNTY
Entity type:Organization
Organization Name:DAKOTA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER ACCTS REC
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-438-4363
Mailing Address - Street 1:1590 HIGHWAY 55
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2343
Mailing Address - Country:US
Mailing Address - Phone:651-438-4636
Mailing Address - Fax:651-438-4603
Practice Address - Street 1:1 MENDOTA RD W STE 300
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-4770
Practice Address - Country:US
Practice Address - Phone:651-438-4539
Practice Address - Fax:651-438-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1144494527Medicaid
MN1285722272Medicaid
MN142127620Medicaid
MN1053409003Medicaid
MN1548424658Medicaid