Organization
SPIRIT LAKE HEAD START
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA LANE KOCH REGISTERED NURSE (HEALTH SERVICE COORDINATOR)
(701) 766-1370
Entity
Organization
Contact information
Practice address
816 3RD AVE NORTH, FORT TOTTEN, ND 58335
(701) 766-4070
(701) 766-1357
Mailing address
816 3RD AVE NORTH, FORT TOTTEN, ND 58335
(701) 766-4070
(701) 766-1357
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
R34550
ND
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
10/22/2010
Last updated
10/22/2010
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