Provider Demographics
NPI:1649589540
Name:ST. CROIX HOSPICE, LLC
Entity Type:Organization
Organization Name:ST. CROIX HOSPICE, LLC
Other - Org Name:ST. CROIX HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-735-3656
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:651-735-0155
Practice Address - Street 1:830 STATE ROAD 136 STE 3
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9255
Practice Address - Country:US
Practice Address - Phone:608-448-4200
Practice Address - Fax:608-448-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2030251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100018729Medicaid
WI521591Medicare Oscar/Certification
WI100018729Medicaid