Provider Demographics
NPI:1568629020
Name:WASHBURN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:WASHBURN COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT
Other - Org Name:WASHBURN COUNTY HEALTH DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-468-4747
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:110 4TH AVE W
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-0250
Mailing Address - Country:US
Mailing Address - Phone:715-468-4747
Mailing Address - Fax:715-468-4753
Practice Address - Street 1:222 OAK ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1440
Practice Address - Country:US
Practice Address - Phone:715-635-4400
Practice Address - Fax:715-635-4416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41523500Medicaid