Healthcare Provider Details

I. General information

NPI: 1306339544
Provider Name (Legal Business Name): COUNTY OF MARINETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HALL AVENUE SUITE B
MARINETTE WI
54143
US

IV. Provider business mailing address

2500 HALL AVENUE 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBIN ELSNER
Title or Position: DIRECTOR
Credential: MSW, LCSW
Phone: 715-732-7763