Provider Demographics
NPI:1851715684
Name:FAMILY & CHILDREN'S CENTER YOUTH ACT
Entity Type:Organization
Organization Name:FAMILY & CHILDREN'S CENTER YOUTH ACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-785-0001
Mailing Address - Street 1:601 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3822
Mailing Address - Country:US
Mailing Address - Phone:507-453-9563
Mailing Address - Fax:507-453-9562
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4200
Practice Address - Country:US
Practice Address - Phone:608-785-0001
Practice Address - Fax:608-785-0002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & CHILDREN'S CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health