Provider Demographics
NPI:1508011479
Name:COUNTY OF GREEN
Entity Type:Organization
Organization Name:COUNTY OF GREEN
Other - Org Name:GREEN COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:608-328-9390
Mailing Address - Street 1:N3150 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-9397
Mailing Address - Country:US
Mailing Address - Phone:608-328-9390
Mailing Address - Fax:608-325-7575
Practice Address - Street 1:N3150 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-9397
Practice Address - Country:US
Practice Address - Phone:608-328-9390
Practice Address - Fax:608-325-7575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF GREEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-19
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44002400Medicaid
WI41521400Medicaid
WI41864100Medicaid
WI41521400Medicaid