Healthcare Provider Details

I. General information

NPI: 1811547037
Provider Name (Legal Business Name): BETHANY-ST JOSEPH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

IV. Provider business mailing address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-5700
  • Fax: 608-788-4030
Mailing address:
  • Phone: 608-788-5700
  • Fax: 608-788-4030

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: KIM GOCHANOUR
Title or Position: CEO
Credential:
Phone: 608-788-5700