Provider Demographics
NPI:1194991299
Name:PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES
Entity type:Organization
Organization Name:PEPIN COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOUINARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-672-8941
Mailing Address - Street 1:740 7TH AVE W
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1628
Mailing Address - Country:US
Mailing Address - Phone:715-672-8941
Mailing Address - Fax:715-672-8593
Practice Address - Street 1:740 7TH AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1628
Practice Address - Country:US
Practice Address - Phone:715-672-8941
Practice Address - Fax:715-672-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100014934Medicaid
WI43111200Medicaid
WI41407000Medicaid
WI43078000Medicaid