Provider Demographics
NPI:1518358977
Name:STRIVE CCS
Entity Type:Organization
Organization Name:STRIVE CCS
Other - Org Name:VERNON COUNTY DHS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-5210
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-0189
Mailing Address - Country:US
Mailing Address - Phone:608-638-7420
Mailing Address - Fax:608-638-7429
Practice Address - Street 1:318 FAIRLANE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-6138
Practice Address - Country:US
Practice Address - Phone:608-637-5210
Practice Address - Fax:608-637-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)