Provider Demographics
NPI:1982155248
Name:THE BETHANY-ST. JOSEPH CORPORATION D/B/A PRAIRIE POINTE REHAB SUITES
Entity Type:Organization
Organization Name:THE BETHANY-ST. JOSEPH CORPORATION D/B/A PRAIRIE POINTE REHAB SUITES
Other - Org Name:PRAIRIE POINTE REHAB SUITES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:UBBELOHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-519-9775
Mailing Address - Street 1:2501 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8037
Mailing Address - Country:US
Mailing Address - Phone:608-788-5700
Mailing Address - Fax:608-788-4030
Practice Address - Street 1:286 N. WILLSON DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-598-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility