Provider Demographics
NPI:1477958510
Name:HOLIDAY HOUSE OF MANITOWOC COUNTY, INC.
Entity Type:Organization
Organization Name:HOLIDAY HOUSE OF MANITOWOC COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-682-4663
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-0579
Mailing Address - Country:US
Mailing Address - Phone:920-682-4663
Mailing Address - Fax:920-682-1091
Practice Address - Street 1:2818 MEADOW LN
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3739
Practice Address - Country:US
Practice Address - Phone:920-682-4663
Practice Address - Fax:920-682-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services