Provider Demographics
NPI:1538163977
Name:COUNTY OF WINONA
Entity type:Organization
Organization Name:COUNTY OF WINONA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOODEW
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:507-457-6400
Mailing Address - Street 1:60 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3431
Mailing Address - Country:US
Mailing Address - Phone:507-457-6400
Mailing Address - Fax:
Practice Address - Street 1:60 W 3RD ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3431
Practice Address - Country:US
Practice Address - Phone:507-457-6400
Practice Address - Fax:507-454-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN328348251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN959253900Medicaid
MN247053Medicare Oscar/Certification