1982155248 NPI number — THE BETHANY-ST. JOSEPH CORPORATION D/B/A PRAIRIE POINTE REHAB SUITES

Table of content: (NPI 1982155248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982155248 NPI number — THE BETHANY-ST. JOSEPH CORPORATION D/B/A PRAIRIE POINTE REHAB SUITES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BETHANY-ST. JOSEPH CORPORATION D/B/A PRAIRIE POINTE REHAB SUITES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982155248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 SHELBY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-8037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-788-5700
Provider Business Mailing Address Fax Number:
608-788-4030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
286 N. WILLSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-598-7800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
UBBELOHDE
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
608-519-9775

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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