Provider Demographics
NPI:1598765125
Name:COUNTY OF BURNETT
Entity Type:Organization
Organization Name:COUNTY OF BURNETT
Other - Org Name:DEPT OF HEALTH & HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-349-7600
Mailing Address - Street 1:7410 COUNTY ROAD K
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-9070
Mailing Address - Country:US
Mailing Address - Phone:715-349-7600
Mailing Address - Fax:715-349-2145
Practice Address - Street 1:7410 COUNTY ROAD K
Practice Address - Street 2:SUITE 280
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-9070
Practice Address - Country:US
Practice Address - Phone:715-349-7600
Practice Address - Fax:715-349-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X, 251K00000X, 251B00000X
WI2630251S00000X
261QF0050X, 261QP2300X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32978371Medicaid
WI41228700Medicaid
WI43070700Medicaid
WI42009500Medicaid
WI41860200Medicaid
WI52D0397132OtherCLIA WAIVER CERT
WI42009500Medicaid
WI41860200Medicaid