Provider Demographics
NPI:1396924916
Name:LENA PUBLIC SCHOOL DISTRICT
Entity type:Organization
Organization Name:LENA PUBLIC SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:WERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-829-5703
Mailing Address - Street 1:304 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:WI
Mailing Address - Zip Code:54139-9488
Mailing Address - Country:US
Mailing Address - Phone:920-829-5703
Mailing Address - Fax:920-829-5122
Practice Address - Street 1:304 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:WI
Practice Address - Zip Code:54139-9488
Practice Address - Country:US
Practice Address - Phone:920-829-5703
Practice Address - Fax:920-829-5122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44240300Medicaid