Provider Demographics
NPI:1992822266
Name:CITY OF RACINE HEALTH DEPARTMENT
Entity type:Organization
Organization Name:CITY OF RACINE HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-636-9202
Mailing Address - Street 1:730 WASHINGTON AVE
Mailing Address - Street 2:ROOM 106
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1146
Mailing Address - Country:US
Mailing Address - Phone:262-636-9201
Mailing Address - Fax:262-636-9564
Practice Address - Street 1:730 WASHINGTON AVE
Practice Address - Street 2:ROOM 106
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1146
Practice Address - Country:US
Practice Address - Phone:262-636-9201
Practice Address - Fax:262-636-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43084100Medicaid
WI2133524001OtherUNITED HEALTHCARE
WI44007900Medicaid
WI32932300Medicaid
WI41862300Medicaid
WI590219OtherDEAN HEALTH PLAN