Provider Demographics
NPI:1831472083
Name:LONGVIEW HOME FOR BOYS
Entity Type:Organization
Organization Name:LONGVIEW HOME FOR BOYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS
Authorized Official - Phone:608-606-3776
Mailing Address - Street 1:E4600 HWY 56
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665
Mailing Address - Country:US
Mailing Address - Phone:608-606-3776
Mailing Address - Fax:608-637-8490
Practice Address - Street 1:E4600 HWY 56
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665
Practice Address - Country:US
Practice Address - Phone:608-606-3776
Practice Address - Fax:608-637-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health