Provider Demographics
NPI:1851963391
Name:STCH HCCMM LLC
Entity Type:Organization
Organization Name:STCH HCCMM LLC
Other - Org Name:ST CROIX HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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 1:7755 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:
Practice Address - Street 1:1517 UNION AVE STE D
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9471
Practice Address - Country:US
Practice Address - Phone:660-263-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based