Healthcare Provider Details

I. General information

NPI: 1134102932
Provider Name (Legal Business Name): VILLAGE OF HARTLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAWN ST
HARTLAND WI
53029-1714
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 262-367-2714
  • Fax: 262-367-2430
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: RYAN BAILEY
Title or Position: FINANCE DIRECTOR
Credential: CPA
Phone: 262-367-2714