Healthcare Provider Details

I. General information

NPI: 1437296456
Provider Name (Legal Business Name): STOUGHTON HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/21/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE ST
STOUGHTON WI
53589-1864
US

IV. Provider business mailing address

900 RIDGE ST
STOUGHTON WI
53589-1864
US

V. Phone/Fax

Practice location:
  • Phone: 608-873-6611
  • Fax: 608-873-2255
Mailing address:
  • Phone: 608-873-6611
  • Fax: 608-873-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. DANIEL C DEGROOT
Title or Position: PRESIDENT
Credential:
Phone: 608-873-2250