Healthcare Provider Details

I. General information

NPI: 1487378956
Provider Name (Legal Business Name): STCH DE PERE WI OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WASHINGTON ST STE A
GREEN BAY WI
54301-4217
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 920-305-7900
  • Fax:
Mailing address:
  • Phone: 651-237-9716
  • Fax:

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: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 651-735-3656