Provider Demographics
NPI:1245541655
Name:SCHOOL DISTRICT OF JANESVILLE
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF JANESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF HEALTH AND SAFETY
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-743-5097
Mailing Address - Street 1:527 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-4779
Mailing Address - Country:US
Mailing Address - Phone:608-743-5097
Mailing Address - Fax:608-743-5068
Practice Address - Street 1:527 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-4779
Practice Address - Country:US
Practice Address - Phone:608-743-5097
Practice Address - Fax:608-743-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1689811432124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164603304Medicaid
WI1477735447Medicaid
WI1962691246Medicaid