Provider Demographics
NPI:1679572788
Name:SOUTHWESTERN WI COMMUNITY ACTION PROGRAM, INC
Entity Type:Organization
Organization Name:SOUTHWESTERN WI COMMUNITY ACTION PROGRAM, INC
Other - Org Name:SWCAP NEIGHBORHOOD HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYNE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BODDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:608-348-9766
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:275 W MAIN ST
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-0704
Mailing Address - Country:US
Mailing Address - Phone:608-348-9766
Mailing Address - Fax:608-348-3915
Practice Address - Street 1:275 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-3110
Practice Address - Country:US
Practice Address - Phone:608-348-9766
Practice Address - Fax:608-348-3915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN WI COMMUNITY ACTION PROGRAM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-20
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44008100Medicaid
WI42005400Medicaid
WI41863200Medicaid
WI43973600Medicaid