Healthcare Provider Details

I. General information

NPI: 1518896539
Provider Name (Legal Business Name): FOND DU LAC COUNTY HUMAN SERVICE GROUP HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 E 9TH ST
FOND DU LAC WI
54935-5056
US

IV. Provider business mailing address

400 UNIVERSITY DR STE A1
FOND DU LAC WI
54935-2997
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-3482
  • Fax:
Mailing address:
  • Phone: 920-929-3446
  • Fax: 920-929-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE PAUL
Title or Position: BUSINESS OPERATION DIVISION MANAGER
Credential:
Phone: 920-929-3446