=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578746194
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERNON COUNTY DEPT OF HUMAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2007
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 318 FAIRLANE DRIVE SUITE 100
-----------------------------------------------------
City | VIROQUA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54665-6140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-637-5210
-----------------------------------------------------
Fax | 608-637-5505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 318 FAIRLANE DRIVE SUITE 100
-----------------------------------------------------
City | VIROQUA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54665-6140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-637-5210
-----------------------------------------------------
Fax | 608-637-5505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. PAMELA J EITLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-637-5210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------