Provider Demographics
NPI:1639291933
Name:CHIPPEWA COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CHIPPEWA COUNTY HEALTH DEPARTMENT
Other - Org Name:CHIPPEWA COUNTY HEALTH DEPARTMENT HOME HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SENKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-635-1566
Mailing Address - Street 1:508 ASHMUN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1976
Mailing Address - Country:US
Mailing Address - Phone:906-635-1568
Mailing Address - Fax:906-253-1466
Practice Address - Street 1:508 ASHMUN ST STE 120
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1976
Practice Address - Country:US
Practice Address - Phone:906-635-1568
Practice Address - Fax:906-253-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030101251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E028OtherBLUE CROSS BLUE SHIELD
MI5173927Medicaid
MI0E028OtherBLUE CROSS BLUE SHIELD
========= 001OtherTRICARE & COMM. INS.