Provider Demographics
NPI:1235321266
Name:FOND DU LAC COUNTY DSS PERSONAL CARE
Entity Type:Organization
Organization Name:FOND DU LAC COUNTY DSS PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SYSTEMS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-929-3437
Mailing Address - Street 1:87 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4510
Mailing Address - Country:US
Mailing Address - Phone:920-929-3437
Mailing Address - Fax:
Practice Address - Street 1:87 VINCENT ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4510
Practice Address - Country:US
Practice Address - Phone:920-929-3437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43103400Medicaid