Basic Information
| Provider Information | |||||||||
| NPI: | 1942651401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THEDACARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549231243 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549231243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203615534 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | BURKHOUSE | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF REHABILITATION SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9203615559 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 13414-24 | WI | Y | Hospitals | General Acute Care Hospital | Rural |
No ID Information.