Provider Demographics
NPI:1861467144
Name:AGNESIAN HEALTHCARE, INC
Entity Type:Organization
Organization Name:AGNESIAN HEALTHCARE, INC
Other - Org Name:SSM HEALTH AT HOME HOME HEALTH FOND DU LAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-356-1423
Mailing Address - Street 1:239 TROWBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-9180
Mailing Address - Country:US
Mailing Address - Phone:920-907-5379
Mailing Address - Fax:
Practice Address - Street 1:239 TROWBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-9180
Practice Address - Country:US
Practice Address - Phone:920-907-5379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41507400Medicaid
527113Medicare Oscar/Certification