Provider Demographics
NPI:1154490845
Name:COUNTY OF MARINETTE
Entity type:Organization
Organization Name:COUNTY OF MARINETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH & HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TOPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-732-7700
Mailing Address - Street 1:2500 HALL AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-7700
Mailing Address - Fax:715-732-7766
Practice Address - Street 1:2500 HALL AVE SUITE B
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-7700
Practice Address - Fax:715-732-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43102200Medicaid