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General NPI Number Information
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NPI Number | 1083837298
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Entity Type | Organization
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Legal Business Name | POLK COUNTY DEPT OF ADMINISTRATION
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 100 POLK COUNTY PLZ STE 180
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City | BALSAM LAKE
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State | WI
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Zip | 54810-8009
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Country | US
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Telephone | 715-485-8400
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Fax | 715-485-8490
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Provider Business Mailing Address
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Address Line | 100 POLK COUNTY PLZ STE 50
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City | BALSAM LAKE
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State | WI
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Zip | 54810-9097
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Country | US
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Telephone | 715-485-8400
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Fax | 715-485-8490
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Authorized Official
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Title or Position | DIRECTOR BUSINESS & OPERATIONS
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Name | KATHLEEN GINGRAS
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Credential |
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Telephone | 715-485-8506
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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 | 2222
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2204
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License Number State | WI
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