Provider Demographics
NPI:1457527400
Name:VILLAGE OF CALEDONIA
Entity type:Organization
Organization Name:VILLAGE OF CALEDONIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:GESNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-898-4460
Mailing Address - Street 1:10005 NORTHWESTERN AVE
Mailing Address - Street 2:#A
Mailing Address - City:FRANKSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53126-9573
Mailing Address - Country:US
Mailing Address - Phone:262-898-4460
Mailing Address - Fax:262-898-4490
Practice Address - Street 1:10005 NORTHWESTERN AVE
Practice Address - Street 2:#A
Practice Address - City:FRANKSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53126-9573
Practice Address - Country:US
Practice Address - Phone:262-835-6429
Practice Address - Fax:262-835-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44017100Medicaid