Provider Demographics
NPI:1184188278
Name:ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Entity Type:Organization
Organization Name:ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Other - Org Name:PREVEA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-496-4700
Mailing Address - Street 1:PO BOX 19070
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:
Practice Address - Street 1:795 WOODLAKE RD STE B
Practice Address - Street 2:
Practice Address - City:KOHLER
Practice Address - State:WI
Practice Address - Zip Code:53044-1315
Practice Address - Country:US
Practice Address - Phone:920-783-3160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF THIRD ORDER OF ST FRAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-23
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies