Healthcare Provider Details

I. General information

NPI: 1497944045
Provider Name (Legal Business Name): MILWAUKEE COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 05/21/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 W CHERRY STREET
MILWAUKEE WI
53205-2117
US

IV. Provider business mailing address

1230 W CHERRY STREET
MILWAUKEE WI
53205-2117
US

V. Phone/Fax

Practice location:
  • Phone: 414-289-6602
  • Fax: 414-289-8524
Mailing address:
  • Phone: 414-289-6602
  • Fax: 414-289-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: RANDY IDING
Title or Position: ACCOUNTING COORDINATOR
Credential:
Phone: 414-289-6105