Healthcare Provider Details

I. General information

NPI: 1770142762
Provider Name (Legal Business Name): ST CROIX HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S POKEGAMA AVE STE D
GRAND RAPIDS MN
55744-3919
US

IV. Provider business mailing address

7755 3RD ST N STE 200
OAKDALE MN
55128-5461
US

V. Phone/Fax

Practice location:
  • Phone: 218-212-7915
  • Fax: 218-301-0725
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: HEATH A BARTNESS
Title or Position: CEO
Credential:
Phone: 651-328-6914