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General NPI Number Information
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NPI Number | 1215085253
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Entity Type | Organization
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Legal Business Name | BLACK RIVER MEMORIAL HOSPITAL INC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 311 COUNTY ROAD A STE 1
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-8205
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Country | US
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Telephone | 715-284-5361
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Fax | 715-284-1398
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Provider Business Mailing Address
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Address Line | 711 W ADAMS ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-9108
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Country | US
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Telephone | 715-284-5361
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Fax | 715-284-1398
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MARY BETH WHITE-JACOBS
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Credential | RN BSN MHA FACHE
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Telephone | 715-284-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 527298
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License Number State | WI
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