Provider Demographics
NPI:1194998716
Name:WISCONSIN CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Entity type:Organization
Organization Name:WISCONSIN CENTER FOR THE BLIND AND VISUALLY IMPAIRED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-758-6100
Mailing Address - Street 1:1700 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-5344
Mailing Address - Country:US
Mailing Address - Phone:608-758-6100
Mailing Address - Fax:608-758-6158
Practice Address - Street 1:1700 W STATE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-5344
Practice Address - Country:US
Practice Address - Phone:608-758-6100
Practice Address - Fax:608-758-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44218100Medicaid