Provider Demographics
NPI:1821589342
Name:DODGE COUNTY MEDICAL FACILITIES
Entity Type:Organization
Organization Name:DODGE COUNTY MEDICAL FACILITIES
Other - Org Name:CLEARVIEW BEHAVIORAL HEALTH 4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-386-3400
Mailing Address - Street 1:198 COUNTY DF
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9515
Mailing Address - Country:US
Mailing Address - Phone:920-386-3400
Mailing Address - Fax:920-386-4168
Practice Address - Street 1:198 COUNTY DF
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9515
Practice Address - Country:US
Practice Address - Phone:920-386-3400
Practice Address - Fax:920-386-4168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5050Other314000000X