Organization
COMMUNITY MEMORIAL HOSPITAL
Active
Parent organization
COMMUNITY MEMORIAL HOSPITAL
Other names
Community Memorial Hospital Social Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY MEMORIAL HOSPITAL
Authorized official
JIM L VAN DORNICK (CEO)
(920) 846-3444
Entity
Organization
Contact information
Practice address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
(920) 846-0250
Mailing address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
(920) 846-0250
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
6699-123
WI
1041C0700X
Clinical Social Worker
Primary
7421-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11014110
—
WI
01
—
1326349135
CMH SB NPI
WI
01
—
1346393287
WINIUS NPI
WI
01
—
1851477913
CMH NPI
WI
01
—
1922270693
FLETCHER NPI
WI
Enumeration date
09/22/2009
Last updated
02/25/2011
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