Healthcare Provider Details

I. General information

NPI: 1538339742
Provider Name (Legal Business Name): COUNTY OF SAUK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BROADWAY ST
BARABOO WI
53913-2183
US

IV. Provider business mailing address

505 BROADWAY ST PO BOX 29
BARABOO WI
53913-2183
US

V. Phone/Fax

Practice location:
  • Phone: 608-355-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2713
License Number StateWI

VIII. Authorized Official

Name: WILLIAM ORTH
Title or Position: DIRECTOR
Credential:
Phone: 608-355-4200