Healthcare Provider Details

I. General information

NPI: 1508839150
Provider Name (Legal Business Name): COMMUNITY ACTION INC OF ROCK & WALWORTH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W BURBANK AVE
JANESVILLE WI
53546-6154
US

IV. Provider business mailing address

2300 KELLOGG AVE
JANESVILLE WI
53546-5921
US

V. Phone/Fax

Practice location:
  • Phone: 608-755-2438
  • Fax: 608-755-2246
Mailing address:
  • Phone: 608-755-2470
  • Fax: 608-755-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number65503030
License Number StateWI

VIII. Authorized Official

Name: MRS. DONNA LEE HAYS
Title or Position: DIRECTOR
Credential: RNC WHNP
Phone: 608-755-2438