Basic Information
| Provider Information | |||||||||
| NPI: | 1679737936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAMS CO HEALTH & HUMAN SERV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | FRIENDSHIP | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539349443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083394505 | ||||||||
| FaxNumber: | 6083394585 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | FRIENDSHIP | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539349443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083394505 | ||||||||
| FaxNumber: | 6083394585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | FISCAL & SUPPORT SERVICES MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6083394505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 1253 | WI | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 43079900 | 05 | WI | MEDICAID |