1497298582 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVIC, INCE

Table of content: (NPI 1497298582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497298582 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVIC, INCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN LUTHERAN CHILD & FAMILY SERVIC, INCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497298582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W175N11120 STONEWOOD DR
Provider Second Line Business Mailing Address:
ATTN: LINDA RANGEL
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53022-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-658-9522
Provider Business Mailing Address Fax Number:
262-345-5531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11655 W MCMILLAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83713-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-438-1772
Provider Business Practice Location Address Fax Number:
262-293-9737
Provider Enumeration Date:
11/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
RANGEL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE COORDINATOR
Authorized Official Telephone Number:
262-345-5533

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  01854 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com