Provider Demographics
NPI:1518133966
Name:UNITED CEREBRAL PALSY OF GREATER DANE COUNTY
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF GREATER DANE COUNTY
Other - Org Name:BIRTH TO THREE CONNECTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-273-4434
Mailing Address - Street 1:2801 COHO ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4574
Mailing Address - Country:US
Mailing Address - Phone:608-273-3232
Mailing Address - Fax:608-273-3426
Practice Address - Street 1:2801 COHO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4574
Practice Address - Country:US
Practice Address - Phone:608-273-3232
Practice Address - Fax:608-273-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI412023000Medicaid