Provider Demographics
NPI:1396910741
Name:PORTAGE COMMUNITY SCHOOLS
Entity type:Organization
Organization Name:PORTAGE COMMUNITY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-742-3599
Mailing Address - Street 1:2600 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1262
Mailing Address - Country:US
Mailing Address - Phone:608-742-3599
Mailing Address - Fax:608-742-3989
Practice Address - Street 1:2600 WOODCREST DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1262
Practice Address - Country:US
Practice Address - Phone:608-742-3599
Practice Address - Fax:608-742-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44201700Medicaid