Provider Demographics
NPI:1417938523
Name:COUNTY OF PIERCE
Entity Type:Organization
Organization Name:COUNTY OF PIERCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-273-6755
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0238
Mailing Address - Country:US
Mailing Address - Phone:715-273-6755
Mailing Address - Fax:715-273-6854
Practice Address - Street 1:412 W KINNE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-9230
Practice Address - Country:US
Practice Address - Phone:715-273-6755
Practice Address - Fax:715-273-6854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIERCE COUNTY HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-07
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI527068Medicare Oscar/Certification