Provider Demographics
NPI:1013351899
Name:DEERFIELD CARE CENER, LLC
Entity Type:Organization
Organization Name:DEERFIELD CARE CENER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-243-3933
Mailing Address - Street 1:1127 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMONDD
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1467
Mailing Address - Country:US
Mailing Address - Phone:715-243-3930
Mailing Address - Fax:
Practice Address - Street 1:575 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017
Practice Address - Country:US
Practice Address - Phone:715-243-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI522626261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2001122Medicaid