Provider Demographics
NPI:1902085533
Name:LAKELAND UNION HIGH SCHOOL
Entity Type:Organization
Organization Name:LAKELAND UNION HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-356-5252
Mailing Address - Street 1:9573 STATE HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9000
Mailing Address - Country:US
Mailing Address - Phone:715-356-5252
Mailing Address - Fax:715-356-1892
Practice Address - Street 1:9573 STATE HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9000
Practice Address - Country:US
Practice Address - Phone:715-356-5252
Practice Address - Fax:715-356-1892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44223700Medicaid