Provider Demographics
NPI:1144274440
Name:COUNTY OF WINNEBAGO
Entity type:Organization
Organization Name:COUNTY OF WINNEBAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-585-4763
Mailing Address - Street 1:216 SOUTH 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436
Mailing Address - Country:US
Mailing Address - Phone:641-585-4763
Mailing Address - Fax:641-585-1788
Practice Address - Street 1:216 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436
Practice Address - Country:US
Practice Address - Phone:641-585-4763
Practice Address - Fax:641-585-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA251E00000X251K00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA67035OtherBLUE CROSS/BLUE SHIELD
IA0670356Medicaid
IA67035OtherBLUE CROSS/BLUE SHIELD