Berlin Pines, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

0014624 Issued in WI

Legal business name

BERLIN PINES, INC

Practice address

642 Broadway
Berlin, WI 54923-1302

Phone

(920) 290-3090

Fax

(920) 290-3090

NPI assigned

Jun 26, 2013

Last updated

Jun 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keri M Haywood

Title

Owner

Phone

(920) 229-3664

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1679913487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 506",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546560506",
            "telephone_number": "920-229-3664",
            "fax_number": "608-487-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 BROADWAY",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231302",
            "telephone_number": "920-290-3090",
            "fax_number": "920-290-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERLIN PINES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-26",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "KERI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-229-3664"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "0014624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison Marie Behnke
• William Donald Bergthold, OTR
• Berlin Area School District
• Berlin Family Eye Care SC
• Berlin Memorial Hospital
• Steven C Blaha, MD
• Katherine Borkovec
• Todd M. Bradshaw, MD
• Jessica M Braun, PTA
• Robert David Brooks, DO

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Berlin, WI
• Providers in Berlin, WI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.