Provider Demographics
NPI:1063638088
Name:COUNTY OF WOOD
Entity Type:Organization
Organization Name:COUNTY OF WOOD
Other - Org Name:BH OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - HUMAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:VRUWINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-421-8800
Mailing Address - Street 1:2611 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6445
Mailing Address - Country:US
Mailing Address - Phone:715-421-8800
Mailing Address - Fax:715-421-2266
Practice Address - Street 1:111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2702
Practice Address - Country:US
Practice Address - Phone:715-421-8800
Practice Address - Fax:715-421-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42140800Medicaid