Provider Demographics
NPI:1326294687
Name:RACINE COUNTY HUMAN SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:RACINE COUNTY HUMAN SERVICES DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSSART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-638-6319
Mailing Address - Street 1:1717 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2405
Mailing Address - Country:US
Mailing Address - Phone:262-638-6695
Mailing Address - Fax:262-638-7045
Practice Address - Street 1:1717 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2405
Practice Address - Country:US
Practice Address - Phone:262-638-6695
Practice Address - Fax:262-638-7045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RACINE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32977871Medicaid