# THEDACARE ACO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THEDACARE, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033519046
- **Legal business name:** THEDACARE, INC.
- **Authorized official:** MR. TIM OLSON CFO (CFO)
- **Authorized official phone:** (920) 830-5950

## Contact information

- **Practice address:** 122 E COLLEGE AVE, APPLETON, WI 54911-5794
- **Practice address phone:** (920) 830-5950
- **Practice address fax:** (920) 830-5910
- **Mailing address:** 122 E COLLEGE AVE, APPLETON, WI 54911-5794
- **Mailing address phone:** (920) 830-5950
- **Mailing address fax:** (920) 830-5910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 08/27/2014
- **Last updated:** 08/27/2014