Provider Demographics
NPI:1821245390
Name:THE THRESHOLD INCORPORATED
Entity Type:Organization
Organization Name:THE THRESHOLD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGERUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-338-1188
Mailing Address - Street 1:600 ROLFS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-2637
Mailing Address - Country:US
Mailing Address - Phone:262-338-1188
Mailing Address - Fax:262-338-9453
Practice Address - Street 1:600 ROLFS AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-2637
Practice Address - Country:US
Practice Address - Phone:262-338-1188
Practice Address - Fax:262-338-9453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41204800Medicaid