Provider Demographics
NPI:1114485562
Name:DARJUNE FOUNDATION, INC.
Entity Type:Organization
Organization Name:DARJUNE FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:SAC-IT
Authorized Official - Phone:920-676-9697
Mailing Address - Street 1:2055 S TANAGER LN
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-4003
Mailing Address - Country:US
Mailing Address - Phone:920-676-9697
Mailing Address - Fax:
Practice Address - Street 1:130 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2748
Practice Address - Country:US
Practice Address - Phone:920-676-9697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child