Provider Demographics
NPI:1992971089
Name:FOREST COUNTY DEPARTMENT OF SOCIAL SERVICES
Entity type:Organization
Organization Name:FOREST COUNTY DEPARTMENT OF SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-478-3351
Mailing Address - Street 1:200 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1415
Mailing Address - Country:US
Mailing Address - Phone:715-478-3351
Mailing Address - Fax:715-478-2847
Practice Address - Street 1:200 E MADISON ST
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1415
Practice Address - Country:US
Practice Address - Phone:715-478-3351
Practice Address - Fax:715-478-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43079200Medicaid