Healthcare Provider Details

I. General information

NPI: 1649589540
Provider Name (Legal Business Name): ST. CROIX HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 03/02/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 STATE ROAD 136 STE 3
BARABOO WI
53913-9255
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 608-448-4200
  • Fax: 608-448-4202
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 Number2030
License Number StateWI

VIII. Authorized Official

Name: MR. HEATH A. BARTNESS
Title or Position: CEO
Credential:
Phone: 651-735-3656