1912113499 NPI number — OLMSTED COUNTY

Table of content: (NPI 1912113499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912113499 NPI number — OLMSTED COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLMSTED COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORRECTIONS RECOVERY SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912113499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 CAMPUS DR. SE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-328-6473
Provider Business Mailing Address Fax Number:
507-328-6473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 4TH ST SE
Provider Second Line Business Practice Location Address:
OLMSTED CO. GOV. CENTER AND WRF
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55904-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-328-7214
Provider Business Practice Location Address Fax Number:
507-287-2371
Provider Enumeration Date:
05/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAAS
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CONTROLLER
Authorized Official Telephone Number:
507-328-6465

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1004055-1CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)