NPIMap

Organization Active NPI

Willowglen Academy, Inc.

  • Developmentally Disabled Services Day Training Agency
  • Milwaukee, WI
National Provider Identifier
1881745776
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
2366 Issued in WI
Legal business name
WILLOWGLEN ACADEMY, INC.
Practice address
3903 W Lisbon Ave
Milwaukee, WI 53208-1835
Phone
(414) 342-2060
Fax
(414) 342-3663
NPI assigned
Jan 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Leonard F Dziubla, LCSW
Title
President & Ceo
Phone
(414) 225-4460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 2366 WI Primary

Addresses

Primary practice location

3903 W Lisbon Ave
Milwaukee, WI 53208-1835

Mailing address

1744 N Farwell Ave
Milwaukee, WI 53202-1806
Phone (414) 225-4460

Other identifiers 2

IdentifierTypeStateIssuer
2366OtherWISTATE LICENSE
43003300MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Willowglen Academy Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1744 N Farwell Ave
Milwaukee, WI 53202
Phone (414) 225-4460

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881745776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1744 N FARWELL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532021806",
            "telephone_number": "414-225-4460",
            "fax_number": "414-225-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 W LISBON AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532081835",
            "telephone_number": "414-342-2060",
            "fax_number": "414-342-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWGLEN ACADEMY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DZIUBLA",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "414-225-4460",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "WI",
            "license": "2366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2366",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43003300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.