Provider Demographics
NPI:1790967602
Name:BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKULAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-373-6144
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:117 EAST FIFTH STREET
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-0100
Mailing Address - Country:US
Mailing Address - Phone:715-373-6144
Mailing Address - Fax:715-373-6130
Practice Address - Street 1:117 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4522
Practice Address - Country:US
Practice Address - Phone:715-373-6144
Practice Address - Fax:715-373-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41221000Medicaid