Healthcare Provider Details

I. General information

NPI: 1073780425
Provider Name (Legal Business Name): GRANT COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HWY 35 AND 61
LANCASTER WI
53813-9306
US

IV. Provider business mailing address

8820 HWY 35 AND 61 P.O. BOX 447
LANCASTER WI
53813-9306
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-2136
  • Fax: 608-723-4834
Mailing address:
  • Phone: 608-723-2136
  • Fax: 608-723-4834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED NAATZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 608-723-2136