Provider Demographics
NPI:1922161926
Name:COUNTY OF MENOMINEE
Entity Type:Organization
Organization Name:COUNTY OF MENOMINEE
Other - Org Name:MENOMINEE COUNTY HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-799-3861
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-0280
Mailing Address - Country:US
Mailing Address - Phone:715-799-3861
Mailing Address - Fax:715-799-3517
Practice Address - Street 1:W3272 WOLF RIVER DR
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-9202
Practice Address - Country:US
Practice Address - Phone:715-799-3861
Practice Address - Fax:715-733-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty