Provider Demographics
NPI:1679752471
Name:SCHOOL DISTRICT OF BRODHEAD
Entity type:Organization
Organization Name:SCHOOL DISTRICT OF BRODHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUPIL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-897-2141
Mailing Address - Street 1:2501 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:WI
Mailing Address - Zip Code:53520-2010
Mailing Address - Country:US
Mailing Address - Phone:608-897-2141
Mailing Address - Fax:608-897-2770
Practice Address - Street 1:2501 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:BRODHEAD
Practice Address - State:WI
Practice Address - Zip Code:53520-2010
Practice Address - Country:US
Practice Address - Phone:608-897-2141
Practice Address - Fax:608-897-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44218600Medicaid