1447760673 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447760673 NPI number — WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
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:
1447760673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2017
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:
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:
800-438-1772
Provider Business Mailing Address Fax Number:
262-293-9737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ULM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56073-1868
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:
10/02/2017

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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