Provider Demographics
NPI:1235288051
Name:SAUK COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:SAUK COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:SAUK COUNTY COMMUNITY SUPPORT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-355-4200
Mailing Address - Street 1:505 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-2183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 6TH ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1202
Practice Address - Country:US
Practice Address - Phone:608-355-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43421900Medicaid