Provider Demographics
NPI:1609209394
Name:WISCONSIN LUTHERAN CHLD AND FAMILY SERVICES
Entity type:Organization
Organization Name:WISCONSIN LUTHERAN CHLD AND FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF IN-HOME CARE PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POLINSKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-345-5567
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:262-345-5530
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:W175N11120 STONEWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6511
Practice Address - Country:US
Practice Address - Phone:262-345-5530
Practice Address - Fax:262-345-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care