Healthcare Provider Details

I. General information

NPI: 1174755136
Provider Name (Legal Business Name): MANITOWOC CO HUMAN SERVICES DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S 8TH ST
MANITOWOC WI
54220-4535
US

IV. Provider business mailing address

PO BOX 1177 926 S 8TH ST
MANITOWOC WI
54221-1177
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-4230
  • Fax: 920-683-4908
Mailing address:
  • Phone: 920-683-4230
  • Fax: 920-683-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1555
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier32977500
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name: MR. BOB ZIEGELBAUER
Title or Position: COUNTY EXECUTIVE
Credential:
Phone: 920-683-5107