Provider Demographics
NPI:1689872673
Name:FOND DU LAC COUNTY DEPARTMENT OF SENIOR SERVICES
Entity Type:Organization
Organization Name:FOND DU LAC COUNTY DEPARTMENT OF SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKAND-CERRO
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:9209-293-1133
Mailing Address - Street 1:160 S MACY ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4241
Mailing Address - Country:US
Mailing Address - Phone:920-929-3113
Mailing Address - Fax:920-929-3115
Practice Address - Street 1:160 S MACY ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4241
Practice Address - Country:US
Practice Address - Phone:920-929-3113
Practice Address - Fax:920-929-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)