State of Wisconsin

NPI #1588703078 in Madison, Wisconsin

Provider Information

NPI Number: 1588703078
Entity Type: Organization
Organization Name: State of Wisconsin
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF WISCONSIN
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Feb 5, 2007
Last Updated: Oct 21, 2010

Practice Location

Address: 317 KNUTSON DR
City: Madison
State: Wisconsin
ZIP Code: 53704-1133
Phone: (608) 301-1946

Authorized Official

Name: MRS. JANICE HOLLING
Title: CENTER DIRECTOR
Phone: (608) 301-9229

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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