Provider Demographics
NPI:1275247389
Name:STS OF GREEN BAY INC
Entity Type:Organization
Organization Name:STS OF GREEN BAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-362-1921
Mailing Address - Street 1:3311 PACKERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9540
Mailing Address - Country:US
Mailing Address - Phone:920-366-5402
Mailing Address - Fax:920-347-1974
Practice Address - Street 1:3311 PACKERLAND DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9540
Practice Address - Country:US
Practice Address - Phone:920-366-5402
Practice Address - Fax:920-429-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care