Provider Demographics
NPI:1336328921
Name:COUNTY OF DANE MONONA GROVE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:COUNTY OF DANE MONONA GROVE SCHOOL DISTRICT
Other - Org Name:MONONA GROVE SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR STUDENT SERVICES & SPECIAL ED
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-221-7660
Mailing Address - Street 1:5301 MONONA DR
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3126
Mailing Address - Country:US
Mailing Address - Phone:608-221-7660
Mailing Address - Fax:608-223-6516
Practice Address - Street 1:5301 MONONA DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3126
Practice Address - Country:US
Practice Address - Phone:608-221-7660
Practice Address - Fax:608-223-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44216200Medicaid