Provider Demographics
NPI:1427031988
Name:COUNTY OF DUNN
Entity Type:Organization
Organization Name:COUNTY OF DUNN
Other - Org Name:COUNTY OF DUNN
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KORPELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-232-1518
Mailing Address - Street 1:3001 US HIGHWAY 12 E STE 225
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-3045
Mailing Address - Country:US
Mailing Address - Phone:715-232-1518
Mailing Address - Fax:715-232-1888
Practice Address - Street 1:3001 US HIGHWAY 12 E
Practice Address - Street 2:SUITE 120
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-5569
Practice Address - Country:US
Practice Address - Phone:715-232-1518
Practice Address - Fax:715-232-1888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DUNN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI51OtherLICENSE NUMBER
WI41522400Medicaid
WI41522400Medicaid