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General NPI Number Information
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NPI Number | 1508859208
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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 | 08/26/2005
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 323 BLACK RIVER AVE
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City | WESTBY
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State | WI
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Zip | 54667-1127
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Country | US
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Telephone | 608-634-3747
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Fax | 608-634-3799
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Provider Business Mailing Address
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Address Line | 323 BLACK RIVER AVE
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City | WESTBY
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State | WI
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Zip | 54667-1127
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Country | US
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Telephone | 608-634-3747
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Fax | 608-634-3799
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Authorized Official
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Title or Position | CEO
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Name | 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 | 2495
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License Number State | WI
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