Provider Demographics
NPI:1215102256
Name:COUNTY OF COLUMBIA
Entity type:Organization
Organization Name:COUNTY OF COLUMBIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOVE
Authorized Official - Suffix:
Authorized Official - Credentials:CSW, LPC
Authorized Official - Phone:608-742-9215
Mailing Address - Street 1:2652 MURPHY RD
Mailing Address - Street 2:P. O. BOX 136
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1094
Mailing Address - Country:US
Mailing Address - Phone:608-742-9227
Mailing Address - Fax:608-742-9700
Practice Address - Street 1:111 E MULLETT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2325
Practice Address - Country:US
Practice Address - Phone:608-742-9227
Practice Address - Fax:608-742-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000083790Medicare PIN