Provider Demographics
NPI:1629273974
Name:WILLOWGLEN ACADEMY-WISCONSIN, INC
Entity Type:Organization
Organization Name:WILLOWGLEN ACADEMY-WISCONSIN, INC
Other - Org Name:WGA COMMUNITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-527-6970
Mailing Address - Street 1:1744 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1806
Mailing Address - Country:US
Mailing Address - Phone:414-225-4460
Mailing Address - Fax:414-225-4475
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3300
Practice Address - Country:US
Practice Address - Phone:414-527-6970
Practice Address - Fax:414-527-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management