Healthcare Provider Details

I. General information

NPI: 1407014020
Provider Name (Legal Business Name): COUNTY OF SHAWANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

IV. Provider business mailing address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-4700
  • Fax: 715-526-5542
Mailing address:
  • Phone: 715-526-4700
  • Fax: 715-526-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1831
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD KANE
Title or Position: DIRECTOR
Credential:
Phone: 715-526-4700