Provider Demographics
NPI:1518137793
Name:VILLAGE OF GREENDALE
Entity Type:Organization
Organization Name:VILLAGE OF GREENDALE
Other - Org Name:GREENDALE HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SHEPEARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:414-423-2110
Mailing Address - Street 1:6500 NORTHWAY
Mailing Address - Street 2:P. O. BOX 257
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-0257
Mailing Address - Country:US
Mailing Address - Phone:414-423-2110
Mailing Address - Fax:414-858-9111
Practice Address - Street 1:5650 PARKING ST
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1836
Practice Address - Country:US
Practice Address - Phone:414-423-2110
Practice Address - Fax:414-858-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
82291Medicare PIN