Provider Demographics
NPI:1407008543
Name:LANGLADE COUNTY
Entity Type:Organization
Organization Name:LANGLADE COUNTY
Other - Org Name:LANGLADE CO HEALTH DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DEPT BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANTONIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-627-6382
Mailing Address - Street 1:1225 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2762
Mailing Address - Country:US
Mailing Address - Phone:715-627-6382
Mailing Address - Fax:715-627-6391
Practice Address - Street 1:1225 LANGLADE RD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2762
Practice Address - Country:US
Practice Address - Phone:715-627-6382
Practice Address - Fax:715-627-6391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANGLADE COUNTY GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43081200Medicaid
WI44017200Medicaid