Provider Demographics
NPI:1407143308
Name:MENTAL HEALTH CENTER OF DANE COUNTY, INC
Entity Type:Organization
Organization Name:MENTAL HEALTH CENTER OF DANE COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-280-2678
Mailing Address - Street 1:625 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2637
Mailing Address - Country:US
Mailing Address - Phone:608-280-2700
Mailing Address - Fax:
Practice Address - Street 1:1848 HWY MM
Practice Address - Street 2:CAMBODIAN TEMPLE
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53575-2117
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42216100Medicaid