Provider Demographics
NPI:1144274648
Name:VILLAGE OF SALEM LAKES KENOSHA COUNTY
Entity type:Organization
Organization Name:VILLAGE OF SALEM LAKES KENOSHA COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:262-843-2439
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-0443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11252 254TH CT
Practice Address - Street 2:
Practice Address - City:TREVOR
Practice Address - State:WI
Practice Address - Zip Code:53179-9138
Practice Address - Country:US
Practice Address - Phone:262-843-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41360300Medicaid
000081041OtherADVOCARE MCHMO
000081041OtherADVOCARE MCHMO
=========018OtherVALLEY HEALTH PLAN
=========018OtherBCBS
WI41360300Medicaid
=========OtherTRICARE