Provider Demographics
NPI:1245697861
Name:MACHT VILLAGE PROGRAMS
Entity type:Organization
Organization Name:MACHT VILLAGE PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-469-9646
Mailing Address - Street 1:3310 MID VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9495
Mailing Address - Country:US
Mailing Address - Phone:920-469-9646
Mailing Address - Fax:
Practice Address - Street 1:3310 MID VALLEY DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9495
Practice Address - Country:US
Practice Address - Phone:920-469-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health