Provider Demographics
NPI:1790309649
Name:COUNTY OF PORTAGE
Entity Type:Organization
Organization Name:COUNTY OF PORTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGING & DISABILITY RESOURCE CENTER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIOTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-346-1412
Mailing Address - Street 1:1519 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:715-346-1401
Mailing Address - Fax:715-346-1418
Practice Address - Street 1:1519 WATER STREET
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-346-1401
Practice Address - Fax:715-346-1418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PORTAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care