Provider Demographics
NPI:1114447455
Name:COUNTY OF WALWORTH
Entity Type:Organization
Organization Name:COUNTY OF WALWORTH
Other - Org Name:WALWORTH COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:JON
Authorized Official - Last Name:NEVICOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:262-741-3200
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1005
Mailing Address - Country:US
Mailing Address - Phone:262-741-3200
Mailing Address - Fax:262-741-3217
Practice Address - Street 1:1910 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4454
Practice Address - Country:US
Practice Address - Phone:262-741-3200
Practice Address - Fax:262-741-3217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WALWORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100071262Medicaid
WI43431600Medicaid
WI44004000Medicaid
WI42124600Medicaid
WI41852800Medicaid
WI43076800Medicaid
WI100008444Medicaid
WI32980200Medicaid