Dycora Transitional Health - Beaver Dam LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2695 Issued in WI

Legal business name

DYCORA TRANSITIONAL HEALTH - BEAVER DAM LLC

Practice address

410 Roedl CT
Beaver Dam, WI 53916-2934

Phone

(920) 887-7191

NPI assigned

Nov 4, 2016

Organization subpart

No

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

Authorized official

Name

Mary Hawkins

Title

Executive

Phone

(920) 887-7191

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1992257109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 ROEDL CT",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162934",
            "telephone_number": "920-887-7191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 ROEDL CT",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162934",
            "telephone_number": "920-887-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYCORA TRANSITIONAL HEALTH - BEAVER DAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE",
        "authorized_official_telephone_number": "920-887-7191"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dodge County Chiropractic Service Corporation (Chiropractic USA)
• Dr S Zec SC
• Dr. Mary Grote
• Michael Dull II, PHARMD
• Brian J Dvorak, PT
• Brenda W Dykstra, OTR
• Lori A Dykstra, OT
• John Mark Eaton, D.D.S.
• Heather Marie Edwards
• Ellen Joyce Ellingsworth, MS, RD, CD

• Skilled Nursing Facility in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; 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.