Basic Information
| Provider Information | |||||||||
| NPI: | 1740553940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST CROIX HOSPICE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. CROIX HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7755 3RD ST N STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551285442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517353656 | ||||||||
| FaxNumber: | 6517350155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1065 N 115TH ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681544423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026094818 | ||||||||
| FaxNumber: | 4025024567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | BARTNESS | ||||||||
| AuthorizedOfficialFirstName: | HEATH | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6517353656 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.