Provider Demographics
NPI:1376724765
Name:FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-436-4360
Mailing Address - Street 1:1501 N IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1615
Mailing Address - Country:US
Mailing Address - Phone:920-438-7146
Mailing Address - Fax:920-436-7148
Practice Address - Street 1:300 CROOKS ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4527
Practice Address - Country:US
Practice Address - Phone:920-436-6800
Practice Address - Fax:920-437-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHFS61.91251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43002300Medicaid