Healthcare Provider Details

I. General information

NPI: 1821682162
Provider Name (Legal Business Name): ST PAUL ELDER SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E 14TH ST
KAUKAUNA WI
54130-3304
US

IV. Provider business mailing address

316 E 14TH ST
KAUKAUNA WI
54130-3304
US

V. Phone/Fax

Practice location:
  • Phone: 920-766-6020
  • Fax: 920-766-9161
Mailing address:
  • Phone: 920-766-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HERMAN
Title or Position: CFO
Credential:
Phone: 920-766-6020