Provider Demographics
NPI:1689679094
Name:ST. CROIX VALLEY SHARED SERVICES, INC.
Entity Type:Organization
Organization Name:ST. CROIX VALLEY SHARED SERVICES, INC.
Other - Org Name:ADORAY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROFTGRUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-684-5020
Mailing Address - Street 1:2231 US HIGHWAY 12
Mailing Address - Street 2:STE 201
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-3269
Mailing Address - Country:US
Mailing Address - Phone:715-684-5020
Mailing Address - Fax:715-688-4444
Practice Address - Street 1:2231 US HIGHWAY 12
Practice Address - Street 2:STE 201
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-3269
Practice Address - Country:US
Practice Address - Phone:715-684-5020
Practice Address - Fax:715-688-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41530800Medicaid
WI527137Medicare PIN