Healthcare Provider Details

I. General information

NPI: 1811940331
Provider Name (Legal Business Name): BLACK RIVER HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W ADAMS ST
BLACK RIVER FALLS WI
54615-9108
US

IV. Provider business mailing address

711 W ADAMS ST
BLACK RIVER FALLS WI
54615-9108
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-5361
  • Fax: 715-284-1390
Mailing address:
  • Phone: 715-284-5361
  • Fax: 715-284-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1037
License Number StateWI

VIII. Authorized Official

Name: CATHERINE M BUKOWSKI
Title or Position: CFO
Credential:
Phone: 715-284-3661