Provider Demographics
NPI:1265447098
Name:WHEATON FRANCISCAN HEALTHCARE-ALL SAINTS, INC.
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE-ALL SAINTS, INC.
Other - Org Name:DIALYSIS WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-687-4886
Mailing Address - Street 1:1139 WARWICK WAY
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5661
Mailing Address - Country:US
Mailing Address - Phone:262-687-7550
Mailing Address - Fax:
Practice Address - Street 1:1139 WARWICK WAY
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5661
Practice Address - Country:US
Practice Address - Phone:262-687-7550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHEATON FRANCUSCAN HEALTHCARE-ALL SAINTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QE0700X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42061100Medicaid
WI523523Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER