Healthcare Provider Details

I. General information

NPI: 1659786259
Provider Name (Legal Business Name): ST CROIX HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LAKE ST STE 3
SPIRIT LAKE IA
51360-1660
US

IV. Provider business mailing address

7755 3RD ST N STE 200
OAKDALE MN
55128-5442
US

V. Phone/Fax

Practice location:
  • Phone: 712-264-5674
  • Fax: 712-580-3043
Mailing address:
  • Phone: 651-735-3656
  • Fax: 651-735-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN PHENNEGER
Title or Position: CFO
Credential:
Phone: 651-328-6934