Healthcare Provider Details

I. General information

NPI: 1346514486
Provider Name (Legal Business Name): SOUTHWESTERN WISCONSIN COMMUNITY ACTION PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S IOWA ST
DODGEVILLE WI
53533-1739
US

IV. Provider business mailing address

201 S IOWA ST
DODGEVILLE WI
53533-1739
US

V. Phone/Fax

Practice location:
  • Phone: 608-930-2191
  • Fax: 608-319-2124
Mailing address:
  • Phone: 608-930-2191
  • Fax: 608-319-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHLEY NEDEAU-OWEN
Title or Position: DIRECTOR TRANSPORTATION DEVELOPMENT
Credential:
Phone: 608-930-2191