Provider Demographics
NPI:1366693509
Name:COUNTY OF MILWAUKEE
Entity Type:Organization
Organization Name:COUNTY OF MILWAUKEE
Other - Org Name:MILWAUKEE COUNTY BEHAVIORAL HEALTH / FISS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-257-5202
Mailing Address - Street 1:9201 W WATERTOWN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3558
Mailing Address - Country:US
Mailing Address - Phone:414-257-7597
Mailing Address - Fax:
Practice Address - Street 1:9201 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3558
Practice Address - Country:US
Practice Address - Phone:414-257-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MILWAUKEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43084724Medicaid