Provider Demographics
NPI:1689368144
Name:STCH ST CLOUD LLC
Entity Type:Organization
Organization Name:STCH ST CLOUD LLC
Other - Org Name:ST CROIX HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-328-6914
Mailing Address - Street 1:3315 ROOSEVELT RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9689
Mailing Address - Country:US
Mailing Address - Phone:320-201-5930
Mailing Address - Fax:
Practice Address - Street 1:3315 ROOSEVELT RD STE 400
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-9689
Practice Address - Country:US
Practice Address - Phone:320-201-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based