Provider Demographics
NPI:1871685073
Name:COUNTY OF OZAUKEE
Entity Type:Organization
Organization Name:COUNTY OF OZAUKEE
Other - Org Name:OZAUKEE COUNTY DEPT OF HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-284-8200
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:CSP/CI/CCS
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1813
Mailing Address - Country:US
Mailing Address - Phone:262-284-8200
Mailing Address - Fax:262-284-8104
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:CSP/CI/CCS
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1813
Practice Address - Country:US
Practice Address - Phone:262-284-8200
Practice Address - Fax:262-284-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43074600Medicaid
WI43421300Medicaid
WI43074600Medicaid