Provider Demographics
NPI:1295243277
Name:RENVILLE COUNTY SOCIAL SERVICES
Entity type:Organization
Organization Name:RENVILLE COUNTY SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-756-6374
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:MOHALL
Mailing Address - State:ND
Mailing Address - Zip Code:58761-0305
Mailing Address - Country:US
Mailing Address - Phone:701-756-6374
Mailing Address - Fax:701-756-6618
Practice Address - Street 1:205 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MOHALL
Practice Address - State:ND
Practice Address - Zip Code:58761-4014
Practice Address - Country:US
Practice Address - Phone:701-756-6374
Practice Address - Fax:701-756-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management