Provider Demographics
NPI:1205904489
Name:CHIPPEWA COUNTY
Entity type:Organization
Organization Name:CHIPPEWA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPT OF HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:RYNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-726-7799
Mailing Address - Street 1:711 N BRIDGE STREET
Mailing Address - Street 2:RM 306
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1876
Mailing Address - Country:US
Mailing Address - Phone:715-726-7799
Mailing Address - Fax:715-726-7736
Practice Address - Street 1:711 N BRIDGE STREET
Practice Address - Street 2:RM 306
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1876
Practice Address - Country:US
Practice Address - Phone:715-726-7799
Practice Address - Fax:715-726-7736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43113600Medicaid