Provider Demographics
NPI:1457345795
Name:WASHINGTON COUNTY WISCONSIN
Entity type:Organization
Organization Name:WASHINGTON COUNTY WISCONSIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-335-6854
Mailing Address - Street 1:531 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2531
Mailing Address - Country:US
Mailing Address - Phone:262-335-4500
Mailing Address - Fax:262-335-4699
Practice Address - Street 1:531 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2531
Practice Address - Country:US
Practice Address - Phone:262-335-4500
Practice Address - Fax:262-335-4699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-01
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2385314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20135300Medicaid
WI20135300Medicaid