MEDICARE: ST CROIX HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	26361	MN

General Provider Information

NPI Number	:	1508018185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CROIX HOSPICE LLC

Provider Business Mailing Address
First Line	:	1175 CENTRE POINTE CIR
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-5500
Country	:	US
Telephone Number	:	651-735-3656
Fax Number	:	651-735-0155

Provider Business Practice Location Address
First Line	:	7200 HUDSON BLVD N STE 100
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-7098
Country	:	US
Telephone Number	:	651-735-3656
Fax Number	:	651-735-0126

Authorized Official
Title or Position	:	CFO AND PRESIDENT
Name	:	STEPHEN PHENNEGER
Credential	:
Telephone Number	:	612-544-6133

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	05/21/2026

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