Provider Demographics
NPI:1508854464
Name:DOUGLAS COUNTY
Entity Type:Organization
Organization Name:DOUGLAS COUNTY
Other - Org Name:DOUGLAS COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR DOUGLAS COUNTY HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHANEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-395-1304
Mailing Address - Street 1:1316 N 14TH ST
Mailing Address - Street 2:STE 400 OR SUITE 324
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-1773
Mailing Address - Country:US
Mailing Address - Phone:715-395-1304
Mailing Address - Fax:715-395-1434
Practice Address - Street 1:1316 N 14TH ST
Practice Address - Street 2:STE 400
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-1773
Practice Address - Country:US
Practice Address - Phone:715-395-1304
Practice Address - Fax:715-395-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44003300Medicaid
WI43085600Medicaid
WI41860700Medicaid
WI43089400Medicaid
WI44003300Medicaid