Provider Demographics
NPI:1083837298
Name:POLK COUNTY DEPT OF ADMINISTRATION
Entity Type:Organization
Organization Name:POLK COUNTY DEPT OF ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-485-8506
Mailing Address - Street 1:100 POLK COUNTY PLZ STE 50
Mailing Address - Street 2:
Mailing Address - City:BALSAM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54810-9097
Mailing Address - Country:US
Mailing Address - Phone:715-485-8400
Mailing Address - Fax:715-485-8490
Practice Address - Street 1:100 POLK COUNTY PLZ STE 180
Practice Address - Street 2:
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-8009
Practice Address - Country:US
Practice Address - Phone:715-485-8400
Practice Address - Fax:715-485-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2222251B00000X
WI251E00000X
WI2204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42218400Medicaid
WI43074800Medicaid
WI84 81085OtherUNITED BEHAVIORAL HEALTH
WI43430200Medicaid
WI31876OtherHEALTH PARTNERS
WI43102400Medicaid
WI37F35POOtherBC BS MN
WI66373OtherPREFERRED ONE
WI42218400Medicaid