Provider Demographics
NPI:1790901627
Name:COUNTY OF IRON
Entity Type:Organization
Organization Name:COUNTY OF IRON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLSON-JANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-561-3636
Mailing Address - Street 1:300 TACONITE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1546
Mailing Address - Country:US
Mailing Address - Phone:715-561-3636
Mailing Address - Fax:715-561-2128
Practice Address - Street 1:300 TACONITE ST
Practice Address - Street 2:STE 201
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1546
Practice Address - Country:US
Practice Address - Phone:715-561-3636
Practice Address - Fax:715-561-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2347251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42225100Medicaid
WI43081900Medicaid
WI32771700Medicaid
WI000028035Medicare ID - Type Unspecified
WI32771700Medicaid