1366431173 NPI number — COUNTY OF KEWAUNEE

Table of content: (NPI 1366431173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366431173 NPI number — COUNTY OF KEWAUNEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF KEWAUNEE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KEWAUNEE CO DEPT HUMAN SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366431173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 LINCOLN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEWAUNEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54216-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-388-7030
Provider Business Mailing Address Fax Number:
920-388-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 LINCOLN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEWAUNEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54216-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-388-7030
Provider Business Practice Location Address Fax Number:
920-388-7044
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANNOYE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
920-388-7030

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  1466 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: 2288 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43423600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32979271 . This is a "MA CRISIS INTERVENTION" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41225200 . This is a "MA PT OT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 42140100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42551900 . This is a "MA ST" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 43073100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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