Provider Demographics
NPI:1134322530
Name:WASHBURN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Entity Type:Organization
Organization Name:WASHBURN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-468-4747
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-0250
Mailing Address - Country:US
Mailing Address - Phone:715-468-4747
Mailing Address - Fax:715-468-4753
Practice Address - Street 1:110 4TH AVE W
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:ID
Practice Address - Zip Code:54871
Practice Address - Country:US
Practice Address - Phone:715-468-4747
Practice Address - Fax:715-468-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43076900251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43104700Medicaid
WI43430000Medicaid
WI43076900Medicaid
WI44009900Medicaid