Provider Demographics
NPI:1225536527
Name:TOWN OF LONG LAKE
Entity Type:Organization
Organization Name:TOWN OF LONG LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KISLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-724-4136
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54542-0138
Mailing Address - Country:US
Mailing Address - Phone:715-674-2263
Mailing Address - Fax:
Practice Address - Street 1:3348 WISCONSIN 139
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:WI
Practice Address - Zip Code:54542
Practice Address - Country:US
Practice Address - Phone:715-674-2263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66049743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport