Provider Demographics
NPI:1285824094
Name:DEPARTMENT OF HEALTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH & FAMILY SERVICES
Other - Org Name:BMCW 13TH STREET
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-220-7958
Mailing Address - Street 1:2745 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3807
Mailing Address - Country:US
Mailing Address - Phone:414-902-5810
Mailing Address - Fax:
Practice Address - Street 1:2745 S 13TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3807
Practice Address - Country:US
Practice Address - Phone:414-902-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43084727Medicaid