Provider Demographics
NPI:1255662789
Name:DG BROTHERS, INC.
Entity Type:Organization
Organization Name:DG BROTHERS, INC.
Other - Org Name:NOVACARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-766-8080
Mailing Address - Street 1:P.O. 0177
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54130-0177
Mailing Address - Country:US
Mailing Address - Phone:920-766-8080
Mailing Address - Fax:920-766-8088
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2402
Practice Address - Country:US
Practice Address - Phone:920-737-6475
Practice Address - Fax:920-766-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center