Provider Demographics
NPI:1942362108
Name:COUNTY OF MONROE CLERK COURT
Entity Type:Organization
Organization Name:COUNTY OF MONROE CLERK COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-269-8620
Mailing Address - Street 1:14400 COUNTY HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-4611
Mailing Address - Country:US
Mailing Address - Phone:608-269-8800
Mailing Address - Fax:608-269-4386
Practice Address - Street 1:14400 COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-4611
Practice Address - Country:US
Practice Address - Phone:608-269-8800
Practice Address - Fax:608-269-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21052600Medicaid