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Organization Active NPI

Fond Du Lac County

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
National Provider Identifier
1053458935
Registry record updated Oct 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FOND DU LAC COUNTY
Practice address
459 E 1St St
Fond Du Lac, WI 54935-4505
Phone
(920) 929-3500
Fax
(920) 929-3129
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lori Rozell
Title
Business Operations Manager
Phone
(920) 929-3500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

459 E 1St St
Fond Du Lac, WI 54935-4505

Mailing address

459 E 1St St
Fond Du Lac, WI 54935-4505
Phone (920) 929-3500

Other identifiers 1

IdentifierTypeStateIssuer
42121200MedicaidWI

Other names 2

  • Department of Human Services Clinical Services Doing business as
  • Fond du Lac County Department of Community Programs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031125000279 WI Part B Supplier - Clinic/Group Practice 2668376245 Receives reassigned benefits from 11 practitioners
Practice locations: Fond Du Lac, WI

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Fond Du Lac County DSS Personal Care14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fond Du Lac CountyFond Du Lac, WI, CCN 524025 Hospital Other Mar 18, 2022
Harbor Haven Health & RehabilitationFond Du Lac, WI, CCN 525534 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Trustee of the SNF
Adp of the SNF		 Jan 1, 1972
Jan 1, 1972
Jan 1, 1972
Jan 1, 1972

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760659200000",
    "number": "1053458935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354505",
            "telephone_number": "920-929-3500",
            "fax_number": "920-929-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354505",
            "telephone_number": "920-929-3500",
            "fax_number": "920-929-3129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2025-10-17",
        "certification_date": "2025-10-17",
        "status": "A",
        "authorized_official_last_name": "ROZELL",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS MANAGER",
        "authorized_official_telephone_number": "920-929-3500"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42121200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Department of Human Services Clinical Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fond du Lac County Department of Community Programs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.