Healthcare Provider Details

I. General information

NPI: 1588941538
Provider Name (Legal Business Name): KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SHERIDAN RD SUITE 100
KENOSHA WI
53143-6506
US

IV. Provider business mailing address

8600 SHERIDAN RD SUITE 100
KENOSHA WI
53143-6506
US

V. Phone/Fax

Practice location:
  • Phone: 262-697-4555
  • Fax: 262-697-4655
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN JANSEN
Title or Position: DIRECTOR
Credential:
Phone: 262-697-4500