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General NPI Number Information
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NPI Number | 1346228541
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Entity Type | Organization
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Legal Business Name | AGNESIAN HEALTHCARE, INC
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 430 E DIVISION ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4560
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Country | US
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Telephone | 920-929-2300
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Fax | 920-926-8885
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Provider Business Mailing Address
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Address Line | 430 E DIVISION ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4560
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Country | US
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Telephone | 920-929-2300
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Fax | 920-926-8885
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Authorized Official
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Title or Position | VP-FINANCE, CFO
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Name | AMY GRINNELL
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Credential |
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Telephone | 608-260-3586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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