Healthcare Provider Details

I. General information

NPI: 1356334205
Provider Name (Legal Business Name): BETHANY-ST JOSEPH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number2540
License Number StateWI

VIII. Authorized Official

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