Provider Demographics
NPI:1093997298
Name:CITY OF RACINE HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF RACINE HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RS, MSHSA
Authorized Official - Phone:262-636-9495
Mailing Address - Street 1:730 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1146
Mailing Address - Country:US
Mailing Address - Phone:262-636-9495
Mailing Address - Fax:262-636-9564
Practice Address - Street 1:730 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1146
Practice Address - Country:US
Practice Address - Phone:262-636-9495
Practice Address - Fax:262-636-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare