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General NPI Number Information
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NPI Number | 1053468066
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Entity Type | Organization
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Legal Business Name | COUNTY OF GRANT
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 1122 PROFESSIONAL DR
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City | DODGEVILLE
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State | WI
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Zip | 53533-1176
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Country | US
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Telephone | 608-935-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W ALONA LN
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City | LANCASTER
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State | WI
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Zip | 53813-2202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COMPTROLLER
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Name | JAN SUDMEIER
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Credential |
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Telephone | 608-723-6357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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