Provider Demographics
NPI:1497819510
Name:COUNTY OF MILWAUKEE
Entity Type:Organization
Organization Name:COUNTY OF MILWAUKEE
Other - Org Name:MILWAUKEE COUNTY BEHAVIORAL HEALTH COMMUNITY SUPPORT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-391-8172
Mailing Address - Street 1:1220 W VLIET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2117
Mailing Address - Country:US
Mailing Address - Phone:414-257-6995
Mailing Address - Fax:
Practice Address - Street 1:1220 W VLIET ST FL 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2117
Practice Address - Country:US
Practice Address - Phone:414-257-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43420800Medicaid
WI00812Medicare ID - Type Unspecified