NPI 1215191127

Kittson County Developmental Achievement Center

Organisation Preferred Provider Organization Lake Bronson, MN

Practice location

Address: 102 Hill Street, Lake Bronson, MN 56734
Phone: (218) 754-2225
Mailing address: 102 Hill Street PO Box 54, Lake Bronson, MN 56734

Authorised official

Name: Corrine Rae Karboviak
Title: Director
Phone: (218) 754-2225

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 801303 (MN)

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Registry record

NPI: 1215191127
Entity type: Organization
NPI issued: 10 Jul 2008
Record last updated: 10 Jul 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.