Provider Demographics
NPI:1952445918
Name:VILLAGE OF WATERFORD
Entity Type:Organization
Organization Name:VILLAGE OF WATERFORD
Other - Org Name:WATERFORD RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VILLAGE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:EWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-534-7912
Mailing Address - Street 1:123 N RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4149
Mailing Address - Country:US
Mailing Address - Phone:262-375-9610
Mailing Address - Fax:262-375-9608
Practice Address - Street 1:122 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-4314
Practice Address - Country:US
Practice Address - Phone:262-375-9610
Practice Address - Fax:262-375-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70010500Medicaid
WI70010500Medicaid