Healthcare Provider Details

I. General information

NPI: 1114248820
Provider Name (Legal Business Name): GRANT REGIONAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S MONROE ST
LANCASTER WI
53813-2054
US

IV. Provider business mailing address

6501 CITY WEST PKWY
EDEN PRAIRIE WI
55344-3248
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-2143
  • Fax:
Mailing address:
  • Phone: 952-653-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DAWN M. BANDY
Title or Position: CFO
Credential:
Phone: 608-723-3202