Healthcare Provider Details

I. General information

NPI: 1508859208
Provider Name (Legal Business Name): BETHANY-ST JOSEPH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 BLACK RIVER AVE
WESTBY WI
54667-1127
US

IV. Provider business mailing address

323 BLACK RIVER AVE
WESTBY WI
54667-1127
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-3747
  • Fax: 608-634-3799
Mailing address:
  • Phone: 608-634-3747
  • Fax: 608-634-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2495
License Number StateWI

VIII. Authorized Official

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