Provider Demographics
NPI:1457566960
Name:COUNTY OF LANGLADE
Entity Type:Organization
Organization Name:COUNTY OF LANGLADE
Other - Org Name:LANGLADE CO HEALTH DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANTONIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-627-6250
Mailing Address - Street 1:1225 LANGLADE RD
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-2762
Mailing Address - Country:US
Mailing Address - Phone:715-627-6520
Mailing Address - Fax:715-627-6391
Practice Address - Street 1:1225 LANGLADE RD
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2762
Practice Address - Country:US
Practice Address - Phone:715-627-6520
Practice Address - Fax:715-627-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44017200Medicaid
WI41852000Medicaid
WI44017200Medicaid