Provider Demographics
NPI:1689849101
Name:SHAWANO COUNTY DEPT. OF SOCIAL SERVICES
Entity Type:Organization
Organization Name:SHAWANO COUNTY DEPT. OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-526-4700
Mailing Address - Street 1:607 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3105
Mailing Address - Country:US
Mailing Address - Phone:715-526-4700
Mailing Address - Fax:715-526-4759
Practice Address - Street 1:607 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3105
Practice Address - Country:US
Practice Address - Phone:715-526-4700
Practice Address - Fax:715-526-4759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWANO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43082300Medicaid