Provider Demographics
NPI:1760902191
Name:AGNESIAN HEALTHCARE INC
Entity Type:Organization
Organization Name:AGNESIAN HEALTHCARE INC
Other - Org Name:AGNESIAN BEYOND BOUNDARIES OF AUTISM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-926-4480
Mailing Address - Street 1:40 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-8049
Mailing Address - Country:US
Mailing Address - Phone:920-907-8201
Mailing Address - Fax:
Practice Address - Street 1:40 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-8049
Practice Address - Country:US
Practice Address - Phone:920-907-8201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2226261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)