Provider Demographics
NPI:1720105042
Name:PEPIN COUNTY
Entity Type:Organization
Organization Name:PEPIN COUNTY
Other - Org Name:PEPIN COUNTY NURSING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEPIN COUNTY BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-672-5961
Mailing Address - Street 1:740 7TH AVE W
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-0039
Mailing Address - Country:US
Mailing Address - Phone:715-672-5961
Mailing Address - Fax:
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:715-672-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41519800Medicaid
WI41519800Medicaid