Provider Demographics
NPI:1144418906
Name:COUNTY OF LAMOURE OFFICE OF AUDITOR
Entity type:Organization
Organization Name:COUNTY OF LAMOURE OFFICE OF AUDITOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESILE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-883-5356
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:100 1 AVE SW
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-0692
Mailing Address - Country:US
Mailing Address - Phone:701-883-5356
Mailing Address - Fax:701-883-5015
Practice Address - Street 1:100 1ST AVENUE SOUTHWEST
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458
Practice Address - Country:US
Practice Address - Phone:701-883-5356
Practice Address - Fax:701-883-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDE-3023251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52155Medicaid