Provider Demographics
NPI:1730376740
Name:DOROTHY'S GARMENT CENTRE
Entity type:Organization
Organization Name:DOROTHY'S GARMENT CENTRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:RFM; CF
Authorized Official - Phone:608-231-1711
Mailing Address - Street 1:2710 MARSHALL CT
Mailing Address - Street 2:#1
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2279
Mailing Address - Country:US
Mailing Address - Phone:608-231-1711
Mailing Address - Fax:
Practice Address - Street 1:2710 MARSHALL CT
Practice Address - Street 2:#1
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2279
Practice Address - Country:US
Practice Address - Phone:608-231-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004000013805301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41650200Medicaid
4331810001Medicare NSC