Provider Demographics
NPI:1205017175
Name:OCONTO COUNTY HEALTH & HUMAN SERVICES
Entity Type:Organization
Organization Name:OCONTO COUNTY HEALTH & HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHACKELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-834-7000
Mailing Address - Street 1:501 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-1612
Mailing Address - Country:US
Mailing Address - Phone:920-834-7000
Mailing Address - Fax:920-834-6889
Practice Address - Street 1:501 PARK AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1612
Practice Address - Country:US
Practice Address - Phone:920-834-7000
Practice Address - Fax:920-834-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32980400Medicaid