Provider Demographics
NPI:1184020042
Name:MIDWEST WISCONSIN CORPORATE GUARDIANSHIP, INC.
Entity Type:Organization
Organization Name:MIDWEST WISCONSIN CORPORATE GUARDIANSHIP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WIEDENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-622-3545
Mailing Address - Street 1:W5461 S COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:WILD ROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54984-9289
Mailing Address - Country:US
Mailing Address - Phone:920-622-3545
Mailing Address - Fax:920-622-3545
Practice Address - Street 1:W5461 S COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-9289
Practice Address - Country:US
Practice Address - Phone:920-622-3545
Practice Address - Fax:920-622-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management