| Organization Name: | COMMUNITY MEMORIAL HOSPITAL |
| NPI Number: | 1629302831 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JIM L VAN DORNICK (CEO) |
| Mailing Address: | 855 S Main St Oconto Falls |
| State: | WI US |
| Postal Code: | 541541241 |
| Phone Number: | 9208463444 |
| Fax Number: | 9208460250 |
| NPI Enumeration Date: | 09/22/2009 |
| NPI Last Update Date: | 02/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6699-123 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |