NPIMap

Organization Active NPI

County of Trempealeau

  • Mental Illness Community Based Residential Treatment Facility
  • Whitehall, WI
National Provider Identifier
1295783124
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
CBRF474 Issued in WI
Legal business name
COUNTY OF TREMPEALEAU
Practice address
18425 Dodge St
Whitehall, WI 54773-8444
Phone
(715) 538-4518
Fax
(715) 538-4535
NPI assigned
May 4, 2006
Organization subpart
Yes
Parent organization
COUNTY OF TREMPEALEAUAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Jerry Deetz, N.H.A.
Title
Executive Director
Phone
(715) 538-4312

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X CBRF474 WI Primary

Addresses

Primary practice location

18425 Dodge St
Whitehall, WI 54773-8444

Mailing address

W20410 State Road 121
Whitehall, WI 54773-9147
Phone (715) 538-4312

Other identifiers 2

IdentifierTypeStateIssuer
0603500000OtherWIFARNAM CBRF COTTAGE
0624000000OtherWIFARNAM CBRF HOUSE

Other names 1

  • TCHCC Farnam Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051205000776 WI Part B Supplier - Clinic/Group Practice 9133149156 Receives reassigned benefits from 6 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Blair, WI; Whithall, WI; Whitehall, WI; Pigeon Falls, WI; Independence, WI

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Trempealeau County NRSG27 organizations share this tax ID, including this one
Part of
Trempealeau County NRSG

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1295783124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W20410 STATE ROAD 121",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547739147",
            "telephone_number": "715-538-4312",
            "fax_number": "715-538-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18425 DODGE ST",
            "city": "WHITEHALL",
            "state": "WI",
            "postal_code": "547738444",
            "telephone_number": "715-538-4518",
            "fax_number": "715-538-4535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF TREMPEALEAU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF TREMPEALEAU",
        "enumeration_date": "2006-05-04",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "DEETZ",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-538-4312",
        "authorized_official_credential": "N.H.A."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "WI",
            "license": "CBRF474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FARNAM CBRF COTTAGE",
            "identifier": "0603500000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FARNAM CBRF HOUSE",
            "identifier": "0624000000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TCHCC Farnam",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TCHCC Farnam",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Whitehall, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.