Provider Demographics
NPI:1992181002
Name:WESTERN REGION RECOVERY & WELLNESS CONSORTIA
Entity Type:Organization
Organization Name:WESTERN REGION RECOVERY & WELLNESS CONSORTIA
Other - Org Name:PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZACHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-726-7787
Mailing Address - Street 1:711 N BRIDGE ST
Mailing Address - Street 2:ROOM 305
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1845
Mailing Address - Country:US
Mailing Address - Phone:715-726-7787
Mailing Address - Fax:715-726-7736
Practice Address - Street 1:740 7TH AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1628
Practice Address - Country:US
Practice Address - Phone:715-672-8941
Practice Address - Fax:715-672-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3065251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3065OtherSTATE OF WISCONSIN CERTIFICATION