Healthcare Provider Details

I. General information

NPI: 1144274440
Provider Name (Legal Business Name): COUNTY OF WINNEBAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SOUTH 4TH STREET
FOREST CITY IA
50436
US

IV. Provider business mailing address

216 SOUTH 4TH STREET
FOREST CITY IA
50436
US

V. Phone/Fax

Practice location:
  • Phone: 641-585-4763
  • Fax: 641-585-1788
Mailing address:
  • Phone: 641-585-4763
  • Fax: 641-585-1788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number251E00000X
License Number StateIA

VIII. Authorized Official

Name: JULIE SORENSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 641-585-4763