Provider Demographics
NPI:1336313956
Name:PEPIN COUNTY OFFICE OF AGING
Entity Type:Organization
Organization Name:PEPIN COUNTY OFFICE OF AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:HATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-672-8936
Mailing Address - Street 1:606 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1025
Mailing Address - Country:US
Mailing Address - Phone:715-672-8936
Mailing Address - Fax:715-672-3598
Practice Address - Street 1:606 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1025
Practice Address - Country:US
Practice Address - Phone:715-672-8936
Practice Address - Fax:715-672-3598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41407000Medicaid