Provider Demographics
NPI:1598944324
Name:TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:TREMPEALEAU COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-538-2311
Mailing Address - Street 1:36245 MAIN ST
Mailing Address - Street 2:PO BOX 67 COURTHOUSE
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9139
Mailing Address - Country:US
Mailing Address - Phone:715-538-2311
Mailing Address - Fax:715-538-4274
Practice Address - Street 1:36245 MAIN ST
Practice Address - Street 2:COURTHOUSE
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-9139
Practice Address - Country:US
Practice Address - Phone:715-538-2311
Practice Address - Fax:715-538-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43425500Medicaid