Provider Demographics
NPI:1689849499
Name:SCHOOL DISTRICT OF WISCONSIN DELLS
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF WISCONSIN DELLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-254-7769
Mailing Address - Street 1:811 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-9636
Mailing Address - Country:US
Mailing Address - Phone:608-254-7769
Mailing Address - Fax:608-254-8058
Practice Address - Street 1:811 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-9636
Practice Address - Country:US
Practice Address - Phone:608-254-7769
Practice Address - Fax:608-254-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44207000Medicaid