Healthcare Provider Details

I. General information

NPI: 1881763571
Provider Name (Legal Business Name): COUNTY OF MARINETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVE SUITE B
MARINETTE WI
54143
US

IV. Provider business mailing address

2500 HALL AVE SUITE B
MARINETTE WI
54143
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-7700
  • Fax: 715-732-7766
Mailing address:
  • Phone: 715-732-7700
  • Fax: 715-732-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GERALD ELSNER
Title or Position: HEALTH AND HUMAN SERVICES DIRECTOR
Credential:
Phone: 715-732-7700