Healthcare Provider Details

I. General information

NPI: 1962691246
Provider Name (Legal Business Name): SCHOOL DISTRICT OF JANESVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S FRANKLIN ST
JANESVILLE WI
53548-4779
US

IV. Provider business mailing address

527 S FRANKLIN ST
JANESVILLE WI
53548-4779
US

V. Phone/Fax

Practice location:
  • Phone: 608-743-5097
  • Fax: 608-743-5068
Mailing address:
  • Phone: 608-743-5097
  • Fax: 608-743-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. MATHEW L. HAEGER
Title or Position: MANAGER OF HEALTH SERVICES
Credential: RN
Phone: 608-743-5097