Healthcare Provider Details

I. General information

NPI: 1346406774
Provider Name (Legal Business Name): EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

IV. Provider business mailing address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-2300
  • Fax:
Mailing address:
  • Phone: 715-839-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2815
License Number StateWI

VIII. Authorized Official

Name: MR. ROY SARGEANT
Title or Position: DIRECTOR
Credential: ACSW
Phone: 715-839-2300