Provider Demographics
NPI:1518181080
Name:LACROSSE COUNTY CARE MANAGEMENT ORGANIZATION
Entity Type:Organization
Organization Name:LACROSSE COUNTY CARE MANAGEMENT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO DME COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-789-4848
Mailing Address - Street 1:2101 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5074
Mailing Address - Country:US
Mailing Address - Phone:608-784-4791
Mailing Address - Fax:
Practice Address - Street 1:1407 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-3301
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty