Provider Demographics
NPI:1518255868
Name:ADRC OF SW WI - IOWA COUNTY
Entity Type:Organization
Organization Name:ADRC OF SW WI - IOWA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-930-9803
Mailing Address - Street 1:303 W CHAPEL ST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1557
Mailing Address - Country:US
Mailing Address - Phone:608-930-9835
Mailing Address - Fax:608-930-1204
Practice Address - Street 1:303 W CHAPEL ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1557
Practice Address - Country:US
Practice Address - Phone:608-930-9835
Practice Address - Fax:608-930-1204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)