Organization
THEDACARE ACO, LLC
Active
Parent organization
THEDACARE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
THEDACARE, INC.
Authorized official
MR. TIM OLSON CFO (CFO)
(920) 830-5950
Entity
Organization
Contact information
Practice address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 830-5950
(920) 830-5910
Mailing address
122 E COLLEGE AVE, APPLETON, WI 54911-5794
(920) 830-5950
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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