1770659658 NPI number — PIERCE COUNTY DEPT OF HUMAN SERVICES

Table of content: (NPI 1770659658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770659658 NPI number — PIERCE COUNTY DEPT OF HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIERCE COUNTY DEPT OF HUMAN SERVICES
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:
1770659658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54011-0670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-273-6770
Provider Business Mailing Address Fax Number:
715-273-6862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 W KINNE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-273-6770
Provider Business Practice Location Address Fax Number:
715-273-6862
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BICHA
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
715-273-6770

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1737 , 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: 43077600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com