Provider Demographics
NPI:1891935912
Name:WILLOWGLEN ACADEMY-WISCONSIN, INC.
Entity Type:Organization
Organization Name:WILLOWGLEN ACADEMY-WISCONSIN, INC.
Other - Org Name:HOWARD JANSEN LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RESIDENTIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-527-6970
Mailing Address - Street 1:W1236 COUNTY HIGHWAY FF
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-5138
Mailing Address - Country:US
Mailing Address - Phone:920-565-2607
Mailing Address - Fax:
Practice Address - Street 1:W1236 COUNTY HIGHWAY FF
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-5138
Practice Address - Country:US
Practice Address - Phone:920-565-2607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOENIX CARE SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health