Provider Demographics
NPI:1669882650
Name:LA SANTE WISCONSIN INC.
Entity type:Organization
Organization Name:LA SANTE WISCONSIN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-465-3000
Mailing Address - Street 1:2021 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-2320
Mailing Address - Country:US
Mailing Address - Phone:920-465-3000
Mailing Address - Fax:920-465-3003
Practice Address - Street 1:1651 S. 41ST STREET
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-465-3000
Practice Address - Fax:920-465-3003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA SANTE WISCONSIN INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2207-45332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0485480003Medicare NSC