Provider Demographics
NPI:1376127548
Name:ST CROIX HOSPICE LLC
Entity Type:Organization
Organization Name:ST CROIX HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-237-9716
Mailing Address - Street 1:7755 3RD ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5461
Mailing Address - Country:US
Mailing Address - Phone:651-735-3656
Mailing Address - Fax:
Practice Address - Street 1:7830 MAIN ST N STE 210
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7069
Practice Address - Country:US
Practice Address - Phone:763-244-2274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based