Healthcare Provider Details

I. General information

NPI: 1487657706
Provider Name (Legal Business Name): ST, JOSEPH'S REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 EAST AVE. SO.
LA CROSSE WI
54601-7297
US

IV. Provider business mailing address

1995 E RUM RIVER DR S
CAMBRIDGE MN
55008-2656
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-9870
  • Fax: 608-787-8889
Mailing address:
  • Phone: 763-689-1162
  • Fax: 763-689-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3275-065
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2809
License Number StateWI

VIII. Authorized Official

Name: KEVIN J RYMANOWSKI
Title or Position: SVP FINANCE
Credential:
Phone: 763-689-1162