Provider Demographics
NPI:1497934038
Name:DOVER 1 KANSASVILLE GRADE SCHOOL
Entity Type:Organization
Organization Name:DOVER 1 KANSASVILLE GRADE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GILES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-878-3773
Mailing Address - Street 1:4101 S BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:KANSASVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53139-9702
Mailing Address - Country:US
Mailing Address - Phone:262-878-3773
Mailing Address - Fax:
Practice Address - Street 1:4101 S BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:KANSASVILLE
Practice Address - State:WI
Practice Address - Zip Code:53139-9702
Practice Address - Country:US
Practice Address - Phone:262-878-3773
Practice Address - Fax:262-878-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44242700Medicaid