Provider Demographics
NPI:1174700611
Name:COUNTRY SERVICES INC
Entity type:Organization
Organization Name:COUNTRY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT COUNTRY SERVICES INC
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:MCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:763-263-7207
Mailing Address - Street 1:641 PARK AVE EAST
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309
Mailing Address - Country:US
Mailing Address - Phone:763-263-7207
Mailing Address - Fax:763-263-7464
Practice Address - Street 1:641 PARK AVE E
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309
Practice Address - Country:US
Practice Address - Phone:763-263-7207
Practice Address - Fax:763-263-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management