Provider Demographics
NPI:1477901833
Name:THEDACARE MEDICAL CENTER BERLIN
Entity Type:Organization
Organization Name:THEDACARE MEDICAL CENTER BERLIN
Other - Org Name:COMMUNITY HEALTH NETWORK
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:REHABILITATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:920-361-5559
Mailing Address - Street 1:225 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1243
Mailing Address - Country:US
Mailing Address - Phone:920-361-5534
Mailing Address - Fax:920-361-5910
Practice Address - Street 1:225 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1243
Practice Address - Country:US
Practice Address - Phone:920-361-5534
Practice Address - Fax:920-361-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2461-19282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural