Provider Demographics
NPI:1124253372
Name:CHILEDA INSTITUE, INC
Entity type:Organization
Organization Name:CHILEDA INSTITUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:WISEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-782-6480
Mailing Address - Street 1:1825 VICTORY ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7201
Mailing Address - Country:US
Mailing Address - Phone:608-782-6480
Mailing Address - Fax:608-782-6992
Practice Address - Street 1:1825 VICTORY ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7201
Practice Address - Country:US
Practice Address - Phone:608-782-6480
Practice Address - Fax:608-782-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1010787320600000X
WI1010781320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities