Organization
COUNTY OF BURNETT
Active
Other names
Dept of Health & Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
STACY HOPKE (FISCAL COORDINATOR)
(715) 349-7600
Entity
Organization
Contact information
Practice address
7410 COUNTY ROAD K, SUITE 280, SIREN, WI 54872-9070
(715) 349-7600
(715) 349-2145
Mailing address
7410 COUNTY ROAD K, SUITE 280, SIREN, WI 54872-9070
(715) 349-7600
(715) 349-2145
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
WI
251K00000X
Public Health or Welfare Agency
—
WI
251S00000X
Community/Behavioral Health Agency
2630
WI
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32978371
—
WI
05
—
41228700
—
WI
05
—
41860200
—
WI
05
—
42009500
—
WI
05
—
43070700
—
WI
01
—
52D0397132
CLIA WAIVER CERT
WI
Enumeration date
07/26/2005
Last updated
12/21/2018
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