Healthcare Provider Details

I. General information

NPI: 1295849784
Provider Name (Legal Business Name): ST. JOSEPH'S COMMUNITY HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WATER AVENUE
HILLSBORO WI
54634
US

IV. Provider business mailing address

PO BOX 527
HILLSBORO WI
54634-0527
US

V. Phone/Fax

Practice location:
  • Phone: 608-489-8000
  • Fax: 608-489-8181
Mailing address:
  • Phone: 608-489-8000
  • Fax: 608-489-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2186
License Number StateWI

VIII. Authorized Official

Name: MS. DEBRA S. SMITH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 608-489-8101