Provider Demographics
NPI:1346406774
Name:EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:715-839-2300
Mailing Address - Street 1:721 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5212
Mailing Address - Country:US
Mailing Address - Phone:715-839-2300
Mailing Address - Fax:
Practice Address - Street 1:721 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5212
Practice Address - Country:US
Practice Address - Phone:715-839-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2815251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32977900Medicaid