Provider Demographics
NPI:1457559262
Name:WILLOWGLEN HEIN FOSTER CARE GROUP HOME
Entity type:Organization
Organization Name:WILLOWGLEN HEIN FOSTER CARE GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR RESIDENTIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-527-6970
Mailing Address - Street 1:207 HEIN AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:WI
Mailing Address - Zip Code:53073-2526
Mailing Address - Country:US
Mailing Address - Phone:920-893-5132
Mailing Address - Fax:
Practice Address - Street 1:207 HEIN AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-2526
Practice Address - Country:US
Practice Address - Phone:920-893-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1005423322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children