Provider Demographics
NPI:1336353226
Name:WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL, INC.
Entity type:Organization
Organization Name:WESTERN DAIRYLAND ECONOMIC OPPORTUNITY COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-985-2391
Mailing Address - Street 1:23122 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54747-0125
Mailing Address - Country:US
Mailing Address - Phone:715-985-2391
Mailing Address - Fax:715-985-3239
Practice Address - Street 1:18520 SCRANTON ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-0128
Practice Address - Country:US
Practice Address - Phone:715-538-2306
Practice Address - Fax:715-538-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42006600Medicaid