Provider Demographics
NPI:1700037694
Name:COUNTY OF MILWAUKEE
Entity Type:Organization
Organization Name:COUNTY OF MILWAUKEE
Other - Org Name:MILWAUKEE COUNTY BEHAVIORAL HEALTH /WRAPAROUND
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-391-8172
Mailing Address - Street 1:1220 W VLIET ST FL 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-2117
Mailing Address - Country:US
Mailing Address - Phone:414-257-7639
Mailing Address - Fax:
Practice Address - Street 1:1220 W VLIET ST FL 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-2117
Practice Address - Country:US
Practice Address - Phone:414-257-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MILWAUKEE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI69005100Medicaid