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Organization
AGNESIAN HEALTHCARE, INC
Active
Organization
AGNESIAN HEALTHCARE, INC
Active
Other names
SSM HEALTH ST AGNES HOSPITAL FOND DU LAC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY GRINNELL (VP-FINANCE, CFO)
(608) 260-3586
Entity
Organization
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
(920) 926-8885
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 929-2300
(920) 926-8885
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
275N00000X
Medicare Defined Swing Bed Hospital Unit
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101159
VESTICA
WI
05
—
11013000
—
WI
01
—
547140
DEAN CARE
WI
Enumeration date
01/06/2006
Last updated
06/05/2024
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