Provider Demographics
NPI:1093908451
Name:WILLOWGLEN ACADEMY - WILSON
Entity Type:Organization
Organization Name:WILLOWGLEN ACADEMY - WILSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-527-6940
Mailing Address - Street 1:3603 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7096
Mailing Address - Country:US
Mailing Address - Phone:920-458-6640
Mailing Address - Fax:866-458-6678
Practice Address - Street 1:3603 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-7096
Practice Address - Country:US
Practice Address - Phone:920-458-6640
Practice Address - Fax:866-458-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children