Provider Demographics
NPI:1205217221
Name:GREATER WI AGENCY ON AGING RESOURCES
Entity type:Organization
Organization Name:GREATER WI AGENCY ON AGING RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/FISCAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULD
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:608-243-5674
Mailing Address - Street 1:1414 MACARTHUR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1318
Mailing Address - Country:US
Mailing Address - Phone:608-243-5674
Mailing Address - Fax:866-782-6158
Practice Address - Street 1:1414 MACARTHUR RD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1318
Practice Address - Country:US
Practice Address - Phone:608-243-5674
Practice Address - Fax:866-782-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management