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General NPI Number Information
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NPI Number | 1215102256
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Entity Type | Organization
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Legal Business Name | COUNTY OF COLUMBIA
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 111 E MULLETT ST
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City | PORTAGE
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State | WI
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Zip | 53901-2325
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Country | US
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Telephone | 608-742-9227
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Fax | 608-742-9700
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Provider Business Mailing Address
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Address Line | 2652 MURPHY RD P. O. BOX 136
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City | PORTAGE
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State | WI
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Zip | 53901-1094
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Country | US
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Telephone | 608-742-9227
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Fax | 608-742-9700
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. HEATHER J GOVE
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Credential | CSW, LPC
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Telephone | 608-742-9215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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