Provider Demographics
NPI:1013157981
Name:AGNESIAN HEALTHCARE
Entity Type:Organization
Organization Name:AGNESIAN HEALTHCARE
Other - Org Name:DOLL AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP & CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-926-5402
Mailing Address - Street 1:1567 E SUMNER ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2608
Mailing Address - Country:US
Mailing Address - Phone:262-670-6794
Mailing Address - Fax:262-670-6795
Practice Address - Street 1:1567 E SUMNER ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-2608
Practice Address - Country:US
Practice Address - Phone:262-670-6794
Practice Address - Fax:262-670-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health