Organization
VILLAGE OF FONTANA ON GENEVA LAKE
Active
Parent organization
VILLAGE OF FONTANA-ON-GENEVA LAKE
Other names
Fontana Fire/Rescue
Organization subpart
Yes
Provider details
NPI number
Legal business name
VILLAGE OF FONTANA-ON-GENEVA LAKE
Authorized official
DENNIS LEE MARTIN (ADMINISTRATOR)
(262) 275-6136
Entity
Organization
Contact information
Practice address
190 FONTANA BOULEVARD, FONTANA, WI 53125-1000
(262) 275-2131
(262) 275-2257
Mailing address
POST OFFICE BOX 200, 175 VALLEY VIEW DRIVE, FONTANA, WI 53125-1192
(262) 275-6136
(262) 275-8088
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
6000137
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41355400
WISCONSIN RENAL PROGRAM
WI
05
—
41355400
—
WI
Enumeration date
06/13/2006
Last updated
07/10/2024
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