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General NPI Number Information
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NPI Number | 1477901833
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Entity Type | Organization
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Legal Business Name | THEDACARE MEDICAL CENTER BERLIN
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 225 MEMORIAL DR
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City | BERLIN
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State | WI
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Zip | 54923-1243
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Country | US
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Telephone | 920-361-5534
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Fax | 920-361-5910
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Provider Business Mailing Address
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Address Line | 225 MEMORIAL DR
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City | BERLIN
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State | WI
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Zip | 54923-1243
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Country | US
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Telephone | 920-361-5534
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Fax | 920-361-5910
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Authorized Official
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Title or Position | REHABILITATION DIRECTOR
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Name | DALE BURKHOUSE
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Credential | ATC
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Telephone | 920-361-5559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 2461-19
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License Number State | WI
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