Provider Demographics
NPI:1447439740
Name:VERNON COUNTY DEPT OF HUMAN SERVICES
Entity type:Organization
Organization Name:VERNON COUNTY DEPT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:EITLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-5210
Mailing Address - Street 1:318 FAIRLANE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-6140
Mailing Address - Country:US
Mailing Address - Phone:608-637-5210
Mailing Address - Fax:608-637-5505
Practice Address - Street 1:318 FAIRLANE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-6140
Practice Address - Country:US
Practice Address - Phone:608-637-5210
Practice Address - Fax:608-637-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43425300Medicaid