Provider Demographics
NPI:1205009859
Name:PECATONICA AREA SCHOOLS
Entity Type:Organization
Organization Name:PECATONICA AREA SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-523-4248
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:BLANCHARDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53516-0117
Mailing Address - Country:US
Mailing Address - Phone:608-523-4248
Mailing Address - Fax:608-523-4286
Practice Address - Street 1:704 CROSS ST
Practice Address - Street 2:
Practice Address - City:BLANCHARDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53516-9744
Practice Address - Country:US
Practice Address - Phone:608-523-4248
Practice Address - Fax:608-523-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44225100Medicaid