Provider Demographics
NPI:1285827667
Name:KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-605-6524
Mailing Address - Street 1:8600 SHERIDAN ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6507
Mailing Address - Country:US
Mailing Address - Phone:262-605-6524
Mailing Address - Fax:262-697-4655
Practice Address - Street 1:8600 SHERIDAN ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6507
Practice Address - Country:US
Practice Address - Phone:262-605-6524
Practice Address - Fax:262-697-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41761100Medicaid
WI41761000Medicaid