Provider Demographics
NPI:1417282260
Name:SOUTH MADISON COALITION OF THE ELDERLY
Entity Type:Organization
Organization Name:SOUTH MADISON COALITION OF THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STOGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-251-8405
Mailing Address - Street 1:128 E OLIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1467
Mailing Address - Country:US
Mailing Address - Phone:608-251-8405
Mailing Address - Fax:
Practice Address - Street 1:128 E OLIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1467
Practice Address - Country:US
Practice Address - Phone:608-251-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIN2580-800251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management