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General NPI Number Information
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NPI Number | 1033102983
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Entity Type | Organization
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Legal Business Name | BETHANY-ST JOSEPH CORPORATION
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Dates
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Enumeration Date | 08/25/2005
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1600 MAIN ST
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City | ONALASKA
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State | WI
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Zip | 54650-2838
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Country | US
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Telephone | 608-783-4681
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Fax | 608-781-8148
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Provider Business Mailing Address
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Address Line | 1600 MAIN ST
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City | ONALASKA
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State | WI
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Zip | 54650-2838
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Country | US
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Telephone | 608-783-4681
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Fax | 608-781-8148
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Authorized Official
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Title or Position | CEO
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Name | MS. KIMBERLY GOCHANOUR
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Credential |
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Telephone | 608-788-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 3160
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License Number State | WI
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