1639329113 NPI number — AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639329113 NPI number — AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1639329113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24670 STATE ROAD 35 70
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
SIREN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54872-4418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-349-7233
Provider Business Mailing Address Fax Number:
715-349-7205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24670 STATE ROAD 35 70
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
SIREN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54872-4418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-349-7233
Provider Business Practice Location Address Fax Number:
715-349-7205
Provider Enumeration Date:
09/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
715-532-9771

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  2632 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42244500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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