Provider Demographics
NPI:1275693178
Name:COUNTY OF ROCK
Entity type:Organization
Organization Name:COUNTY OF ROCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-757-5152
Mailing Address - Street 1:1717 CENTER AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2818
Mailing Address - Country:US
Mailing Address - Phone:608-757-5152
Mailing Address - Fax:608-757-5116
Practice Address - Street 1:3530 N CTY TRK F
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53547-0726
Practice Address - Country:US
Practice Address - Phone:608-757-5152
Practice Address - Fax:608-757-5116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK COUNTY HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43075200Medicaid