Provider Demographics
NPI:1740273358
Name:LAFAYETTE COUNTY
Entity type:Organization
Organization Name:LAFAYETTE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCHUHMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:608-776-4800
Mailing Address - Street 1:15701 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-0130
Mailing Address - Country:US
Mailing Address - Phone:608-776-4800
Mailing Address - Fax:608-776-4890
Practice Address - Street 1:15701 COUNTY ROAD K
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-9207
Practice Address - Country:US
Practice Address - Phone:608-776-4800
Practice Address - Fax:608-776-4914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X, 251E00000X, 261QD1600X
WI1490261QM0801X
WI2279261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43073300Medicaid
WI42139000Medicaid
WI43104500Medicaid
WI43427700Medicaid
WIE16547Medicare UPIN
WI000084307Medicare PIN