Healthcare Provider Details

I. General information

NPI: 1841443926
Provider Name (Legal Business Name): COUNTY OF WALWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 COUNTY ROAD NN
ELKHORN WI
53121-4454
US

IV. Provider business mailing address

PO BOX 1005
ELKHORN WI
53121-1005
US

V. Phone/Fax

Practice location:
  • Phone: 262-741-3200
  • Fax: 262-741-3217
Mailing address:
  • Phone: 262-741-3200
  • Fax: 262-741-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLO JON NEVICOSI
Title or Position: DIRECTOR
Credential: MSW, LCSW
Phone: 262-741-3200