Provider Demographics
NPI:1700466588
Name:COUNTY OF TREMPEALEAU
Entity Type:Organization
Organization Name:COUNTY OF TREMPEALEAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD ACCOUNT CLERK
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-538-4312
Mailing Address - Street 1:W20410 STATE ROAD 121
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-9147
Mailing Address - Country:US
Mailing Address - Phone:715-538-9136
Mailing Address - Fax:
Practice Address - Street 1:N36585 COUNTY ROAD QQQ
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-4401
Practice Address - Country:US
Practice Address - Phone:715-538-9136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF TREMPEALEAU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness