Provider Demographics
NPI:1174655567
Name:COUNTY OF WAUKESHA DEPARTMENT OF FINANCE
Entity Type:Organization
Organization Name:COUNTY OF WAUKESHA DEPARTMENT OF FINANCE
Other - Org Name:WAUKESHA COUNTY (CRISIS INTERVENTION)
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-548-8431
Mailing Address - Street 1:514 RIVERVIEW AVE
Mailing Address - Street 2:ATTN: FISCAL DEPARTMENT
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3632
Mailing Address - Country:US
Mailing Address - Phone:262-548-7665
Mailing Address - Fax:262-970-6696
Practice Address - Street 1:514 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3632
Practice Address - Country:US
Practice Address - Phone:262-548-7666
Practice Address - Fax:262-970-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32976100251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32976100OtherMA PROVIDER NUMBER
WI32976100Medicaid