Provider Demographics
NPI:1306864939
Name:SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Entity Type:Organization
Organization Name:SAINT ELIZABETHS HOSPITAL OF WABASHA INC
Other - Org Name:GUNDERSEN ST. ELIZABETH'S HOSPITAL AND CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-565-5553
Mailing Address - Street 1:1200 GRANT BLVD W
Mailing Address - Street 2:
Mailing Address - City:WABASHA
Mailing Address - State:MN
Mailing Address - Zip Code:55981-1042
Mailing Address - Country:US
Mailing Address - Phone:651-565-4531
Mailing Address - Fax:651-565-2482
Practice Address - Street 1:1200 GRANT BLVD W
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1042
Practice Address - Country:US
Practice Address - Phone:651-565-4531
Practice Address - Fax:651-565-2482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ELIZABETH'S HOSPITAL OF WABASHA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN330781314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1895NELOtherBCBS NURSING HOME
WI82693400Medicaid
MNNH0451OtherUCARE FOR NURSING HOME
MNNH0451OtherUCARE FOR NURSING HOME