Provider Demographics
NPI:1326149964
Name:VILLAGE OF GREENDALE
Entity Type:Organization
Organization Name:VILLAGE OF GREENDALE
Other - Org Name:GREENDALE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-423-2100
Mailing Address - Street 1:6500 NORTHWAY
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1815
Mailing Address - Country:US
Mailing Address - Phone:414-423-2100
Mailing Address - Fax:414-423-2107
Practice Address - Street 1:6500 NORTHWAY
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1815
Practice Address - Country:US
Practice Address - Phone:414-423-2100
Practice Address - Fax:414-423-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41308000Medicaid
WI=========014OtherBLUE CROSS BLUE SHIELD
WI41308000Medicaid