Healthcare Provider Details

I. General information

NPI: 1174027742
Provider Name (Legal Business Name): COUNTY OF IRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TACONITE ST STE 201
HURLEY WI
54534-1545
US

IV. Provider business mailing address

300 TACONITE ST STE 201
HURLEY WI
54534-1545
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-3636
  • Fax: 715-561-2128
Mailing address:
  • Phone: 715-561-3636
  • Fax: 715-561-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3193
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number3193
License Number StateWI

VIII. Authorized Official

Name: REBECCA J REIN
Title or Position: PROGRAM MANAGER
Credential:
Phone: 715-561-3636