Provider Demographics
NPI:1629078787
Name:ST. NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Entity Type:Organization
Organization Name:ST. NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST. FRANCIS
Other - Org Name:ST NICHOLAS HOSPITAL HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-884-5660
Mailing Address - Street 1:3100 SUPERIOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-459-8300
Mailing Address - Fax:920-452-8336
Practice Address - Street 1:3100 SUPERIOR AVENUE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-459-8300
Practice Address - Fax:920-452-8336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. NICHOLAS HOSPITAL OF THE HOSPITAL SISTERS OF ST. FRANCIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-29
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41524300Medicaid
WI527139Medicare UPIN
WI527139Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER NUMB