Provider Demographics
NPI:1487657706
Name:ST, JOSEPH'S REHABILITATION CENTER
Entity Type:Organization
Organization Name:ST, JOSEPH'S REHABILITATION CENTER
Other - Org Name:CATHOLIC RESIDENTIAL SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYMANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-689-1162
Mailing Address - Street 1:1995 E RUM RIVER DR S
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-2656
Mailing Address - Country:US
Mailing Address - Phone:763-689-1162
Mailing Address - Fax:763-689-6117
Practice Address - Street 1:2902 EAST AVE. SO.
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7297
Practice Address - Country:US
Practice Address - Phone:608-788-9870
Practice Address - Fax:608-787-8889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC RESIDENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-31
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3275-065314000000X
WI2809314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525438Medicare PIN
WI20129100Medicaid