# BLACK RIVER MEMORIAL HOSPITAL INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215085253
- **Authorized official:** MARY BETH WHITE-JACOBS RN BSN MHA FACHE (PRESIDENT & CEO)
- **Authorized official phone:** (715) 284-5361

## Contact information

- **Practice address:** 311 COUNTY ROAD A STE 1, BLACK RIVER FALLS, WI 54615-8205
- **Practice address phone:** (715) 284-5361
- **Practice address fax:** (715) 284-1398
- **Mailing address:** 711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9108
- **Mailing address phone:** (715) 284-5361
- **Mailing address fax:** (715) 284-1398

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 527298 | WI | Yes |

## Other

- **Enumeration date:** 01/08/2007
- **Last updated:** 12/16/2016