Provider Demographics
NPI:1295964435
Name:POLK COUNTY-DEPT OF ADMINISTRATION
Entity type:Organization
Organization Name:POLK COUNTY-DEPT OF ADMINISTRATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-485-8500
Mailing Address - Street 1:100 POLK COUNTY PLZ
Mailing Address - Street 2:STE 180
Mailing Address - City:BALSAM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54810-9071
Mailing Address - Country:US
Mailing Address - Phone:715-485-8500
Mailing Address - Fax:715-485-8500
Practice Address - Street 1:100 POLK COUNTY PLZ
Practice Address - Street 2:STE 1801
Practice Address - City:BALSAM LAKE
Practice Address - State:WI
Practice Address - Zip Code:54810-9071
Practice Address - Country:US
Practice Address - Phone:715-485-8500
Practice Address - Fax:715-485-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41850000Medicaid