Provider Demographics
NPI:1497927677
Name:VALLEY PACKAGING INDUSTRIES, INC.
Entity Type:Organization
Organization Name:VALLEY PACKAGING INDUSTRIES, INC.
Other - Org Name:EARLY INTERVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RUDIG
Authorized Official - Suffix:
Authorized Official - Credentials:MSE, ECSE
Authorized Official - Phone:920-749-5870
Mailing Address - Street 1:3375 W BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-1602
Mailing Address - Country:US
Mailing Address - Phone:920-749-5870
Mailing Address - Fax:920-749-5874
Practice Address - Street 1:3375 W BREWSTER ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1602
Practice Address - Country:US
Practice Address - Phone:920-749-5870
Practice Address - Fax:920-749-5874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41217600Medicaid