Provider Demographics
NPI:1184836413
Name:COUNTY OF LANGLADE
Entity Type:Organization
Organization Name:COUNTY OF LANGLADE
Other - Org Name:LANGLADE CO DEPT OF SOCIAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANTONIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-627-6500
Mailing Address - Street 1:1225 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2762
Mailing Address - Country:US
Mailing Address - Phone:715-627-6500
Mailing Address - Fax:715-627-6295
Practice Address - Street 1:1225 LANGLADE RD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2762
Practice Address - Country:US
Practice Address - Phone:715-627-6500
Practice Address - Fax:715-627-6295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43079000Medicaid