Provider Demographics
NPI:1285847145
Name:COUNTY OF FOREST
Entity Type:Organization
Organization Name:COUNTY OF FOREST
Other - Org Name:FOREST COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-478-3371
Mailing Address - Street 1:200 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1415
Mailing Address - Country:US
Mailing Address - Phone:715-478-3371
Mailing Address - Fax:715-478-5171
Practice Address - Street 1:200 E MADISON ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1415
Practice Address - Country:US
Practice Address - Phone:715-478-3371
Practice Address - Fax:715-478-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44015600Medicaid
WI43084900Medicaid
WI41867800Medicaid