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General NPI Number Information
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NPI Number | 1568196764
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Entity Type | Organization
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Legal Business Name | BLACK RIVER HEALTH INC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 610 W ADAMS ST
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City | BLACK RIVER FALLS
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State | WI
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Zip | 54615-9110
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Country | US
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Telephone | 715-284-4311
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Fax |
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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 | 54615-5052
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Country | US
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Telephone | 715-284-5361
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CATHERINE M BUKOWSKI
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Credential |
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Telephone | 715-284-3661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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