Provider Demographics
NPI:1568867307
Name:COUNTY OF GRANT DBA UNIFIED COMMUNITY SERVICES
Entity Type:Organization
Organization Name:COUNTY OF GRANT DBA UNIFIED COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON-RINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-723-6357
Mailing Address - Street 1:200 W ALONA LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2202
Mailing Address - Country:US
Mailing Address - Phone:608-723-6357
Mailing Address - Fax:608-723-4417
Practice Address - Street 1:200 W ALONA LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2202
Practice Address - Country:US
Practice Address - Phone:608-723-6357
Practice Address - Fax:608-723-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42127200Medicaid
WI42149100Medicaid
WI000088351Medicare PIN
WI42127200Medicaid