Provider Demographics
NPI:1205008083
Name:SCHOOL DISTRICT OF HOLMEN
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF HOLMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-526-1308
Mailing Address - Street 1:1019 MCHUGH RD
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9296
Mailing Address - Country:US
Mailing Address - Phone:608-526-1310
Mailing Address - Fax:608-526-1333
Practice Address - Street 1:1019 MCHUGH RD
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9296
Practice Address - Country:US
Practice Address - Phone:608-526-1310
Practice Address - Fax:608-526-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44221500Medicaid