Provider Demographics
NPI:1952421190
Name:ASHLAND AREA COUNCIL ON ALCOHOLISM AND OTHER DRUG ABUSE, INC.
Entity Type:Organization
Organization Name:ASHLAND AREA COUNCIL ON ALCOHOLISM AND OTHER DRUG ABUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ESALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-682-5207
Mailing Address - Street 1:502 MAIN ST W STE 305
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1512
Mailing Address - Country:US
Mailing Address - Phone:715-682-5207
Mailing Address - Fax:715-682-5209
Practice Address - Street 1:502 MAIN ST W STE 305
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1512
Practice Address - Country:US
Practice Address - Phone:715-682-5207
Practice Address - Fax:715-682-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI017067251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42116300Medicaid
=========OtherFEDERAL TAX ID