Active NPI
County of Kewaunee
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kewaunee, WI
National Provider Identifier
1366431173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- License
- 1466
- Legal business name
- COUNTY OF KEWAUNEE
- Doing business as
- Kewaunee Co Dept Human Services
- Practice address
- 810 Lincoln Street
Kewaunee, WI 54216-1140 - Phone
- (920) 388-7030
- Fax
- (920) 388-7044
- NPI assigned
- Oct 14, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Melissa M Annoye
- Title
- Director
- Phone
- (920) 388-7030
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | 1466 | WI | Primary |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | 2288 | WI |
Addresses
Primary practice location
810 Lincoln Street
Kewaunee, WI 54216-1140
Mailing address
810 Lincoln Street
Kewaunee, WI 54216-1140
Phone (920) 388-7030
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43423600 | Medicaid | WI | |
| 32979271 | Other | WI | MA CRISIS INTERVENTION |
| 41225200 | Other | WI | MA PT OT |
| 42140100 | Medicaid | WI | |
| 42551900 | Other | WI | MA ST |
| 43073100 | Medicaid | WI |
Other names 1
- Kewaunee Co Dept Human Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051019000720 | WI | Part B Supplier - Clinic/Group Practice | 1052337060 |
Receives reassigned benefits from 4 practitioners Practice locations: Kewaunee, WI |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- County of Kewaunee
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Public Health or Welfare Agency
- Kewaunee, WI
- NPI 1710909775
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatry Physician
- Menomonee Falls, WI
- NPI 1689653214
-
- Marriage & Family Therapist
- Kewaunee, WI
- NPI 1619497344
-
- Psychiatry Physician
- Oshkosh, WI
- NPI 1326032335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129248000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1684368000000",
"number": "1366431173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 LINCOLN STREET",
"city": "KEWAUNEE",
"state": "WI",
"postal_code": "542161140",
"telephone_number": "920-388-7030",
"fax_number": "920-388-7044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 LINCOLN STREET",
"city": "KEWAUNEE",
"state": "WI",
"postal_code": "542161140",
"telephone_number": "920-388-7030",
"fax_number": "920-388-7044"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF KEWAUNEE",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-14",
"last_updated": "2023-05-18",
"certification_date": "2023-05-18",
"status": "A",
"authorized_official_last_name": "ANNOYE",
"authorized_official_first_name": "MELISSA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "920-388-7030",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": "WI",
"license": "1466",
"primary": true
},
{
"code": "261QR0405X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
"state": "WI",
"license": "2288",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43423600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA CRISIS INTERVENTION",
"identifier": "32979271",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA PT OT",
"identifier": "41225200",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42140100",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA ST",
"identifier": "42551900",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43073100",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kewaunee Co Dept Human Services",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kewaunee Co Dept Human Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Kewaunee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2023; 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.