Provider Demographics
NPI:1740469733
Name:TREVOR-WILMOT CONSOLIDATED GRADE SCHOOL DISTRICT
Entity type:Organization
Organization Name:TREVOR-WILMOT CONSOLIDATED GRADE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-862-2356
Mailing Address - Street 1:26325 WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179-9701
Mailing Address - Country:US
Mailing Address - Phone:262-862-2356
Mailing Address - Fax:262-862-9226
Practice Address - Street 1:26325 WILMOT RD
Practice Address - Street 2:
Practice Address - City:TREVOR
Practice Address - State:WI
Practice Address - Zip Code:53179-9701
Practice Address - Country:US
Practice Address - Phone:262-862-2356
Practice Address - Fax:262-862-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44243000Medicaid