Organization
CLAY COUNTY
Active
Other names
Clay County Public Health
Organization subpart
No
Provider details
NPI number
Authorized official
LORI J JOHNSON (CLAY COUNTY AUDITOR)
(218) 299-5262
Entity
Organization
Contact information
Practice address
715 11TH ST N, STE 303, MOORHEAD, MN 56560-2083
(218) 299-7301
(218) 299-5795
Mailing address
715 11TH ST N STE 303, MOORHEAD, MN 56560-2083
(218) 299-7301
(218) 299-5195
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427753800
—
MN
01
—
4C45CL
BLUE PLUS DETOX PROVIDER
MN
01
—
5060753
MEDICA UBH PROVIDER
MN
01
—
8300104
MEDICA PMAP PROVIDER
MN
01
—
8G510CL
BLUE PLUS PROVIDER ID
MN
Enumeration date
04/13/2007
Last updated
01/03/2020
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