Provider Demographics
NPI:1841271665
Name:COUNTY OF CHIPPEWA
Entity type:Organization
Organization Name:COUNTY OF CHIPPEWA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY HEALTH OFFICER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:715-726-7900
Mailing Address - Street 1:711 N BRIDGE ST RM 121
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1845
Mailing Address - Country:US
Mailing Address - Phone:715-726-7900
Mailing Address - Fax:715-726-7910
Practice Address - Street 1:711 N BRIDGE ST RM 121
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1845
Practice Address - Country:US
Practice Address - Phone:715-726-7900
Practice Address - Fax:715-726-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41518300Medicaid
WI527019Medicare ID - Type UnspecifiedHOME HEALTH MEDICARE
WI41518300Medicaid