Provider Demographics
NPI:1851566244
Name:COLUMBIA COUNTY HHSD
Entity Type:Organization
Organization Name:COLUMBIA COUNTY HHSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRITZL
Authorized Official - Suffix:
Authorized Official - Credentials:MMSW,APSW
Authorized Official - Phone:608-742-9215
Mailing Address - Street 1:2652 MURPHY RD
Mailing Address - Street 2:P. O. BOX 136
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1094
Mailing Address - Country:US
Mailing Address - Phone:608-742-9227
Mailing Address - Fax:608-742-9700
Practice Address - Street 1:2652 MURPHY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1094
Practice Address - Country:US
Practice Address - Phone:608-742-9227
Practice Address - Fax:608-742-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43429200Medicaid