Organization
FOND DU LAC COUNTY DCP CCS PROGRAM
Active
Parent organization
FOND DU LAC COUNTY
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC COUNTY
Authorized official
RUTH RYAN (BUSINESS SYSTEMS MANAGER)
(920) 929-3437
Entity
Organization
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3500
Mailing address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41762900
—
WI
Enumeration date
04/10/2008
Last updated
04/10/2008
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