Healthcare Provider Details

I. General information

NPI: 1255339867
Provider Name (Legal Business Name): GRANT REGIONAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S MONROE ST
LANCASTER WI
53813-2054
US

IV. Provider business mailing address

507 S MONROE ST ATTN: ADMINISTRATION
LANCASTER WI
53813-2054
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-2143
  • Fax:
Mailing address:
  • Phone: 608-723-2143
  • Fax: 608-723-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL GEHLING
Title or Position: CFO
Credential:
Phone: 608-723-3202