Provider Demographics
NPI:1235120791
Name:CALUMET COUNTY
Entity Type:Organization
Organization Name:CALUMET COUNTY
Other - Org Name:CALUMET COUNTY HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMENESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-849-1448
Mailing Address - Street 1:206 COURT ST
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014-1127
Mailing Address - Country:US
Mailing Address - Phone:920-849-1423
Mailing Address - Fax:920-849-1476
Practice Address - Street 1:206 COURT ST
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014-1127
Practice Address - Country:US
Practice Address - Phone:920-849-1493
Practice Address - Fax:920-849-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI557251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43188600Medicaid
WI521563Medicare ID - Type UnspecifiedHOSPICE AGENCY