NPIMap

Organization Active NPI

Kittson County Developmental Achievement Center

  • Preferred Provider Organization
  • Lake Bronson, MN
National Provider Identifier
1215191127
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
801303 Issued in MN
Legal business name
KITTSON COUNTY DEVELOPMENTAL ACHIEVEMENT CENTER
Practice address
102 Hill Street
Lake Bronson, MN 56734
Phone
(218) 754-2225
NPI assigned
Jul 10, 2008
Last updated
Jul 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 801303 MN Primary

Addresses

Primary practice location

102 Hill Street
Lake Bronson, MN 56734

Mailing address

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

Other names 1

  • Kittson County DAC Other name

National Provider Directory

National Provider Directory

Locations

102 Hill St
Lake Bronson, MN 56734
Phone (218) 754-2225

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1215191127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 HILL STREET",
            "address_2": "PO BOX 54",
            "city": "LAKE BRONSON",
            "state": "MN",
            "postal_code": "56734",
            "telephone_number": "218-754-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 HILL STREET",
            "city": "LAKE BRONSON",
            "state": "MN",
            "postal_code": "56734",
            "telephone_number": "218-754-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTSON COUNTY DEVELOPMENTAL ACHIEVEMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "KARBOVIAK",
        "authorized_official_first_name": "CORRINE",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "218-754-2225"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MN",
            "license": "801303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kittson County DAC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.