Provider Demographics
NPI:1811176464
Name:UNION GROVE UNION HIGH SCHOOL
Entity type:Organization
Organization Name:UNION GROVE UNION HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-878-2434
Mailing Address - Street 1:3433 S COLONY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-9601
Mailing Address - Country:US
Mailing Address - Phone:262-878-2434
Mailing Address - Fax:262-878-4056
Practice Address - Street 1:3433 S COLONY AVE
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9601
Practice Address - Country:US
Practice Address - Phone:262-878-2434
Practice Address - Fax:262-878-4056
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44242400Medicaid