# AGNESIAN HEALTHCARE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM HEALTH ST AGNES HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578541785
- **Authorized official:** STEVEN LITTLE (SVP & CFO)
- **Authorized official phone:** (920) 926-5402

## Contact information

- **Practice address:** 430 E DIVISION ST, FOND DU LAC, WI 54935-4560
- **Practice address phone:** (920) 929-2300
- **Practice address fax:** (920) 926-8885
- **Mailing address:** 430 E DIVISION ST, FOND DU LAC, WI 54935-4560
- **Mailing address phone:** (920) 926-4472
- **Mailing address fax:** (920) 926-8885

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/06/2006
- **Last updated:** 03/12/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 101159 | VESTICA | WI |
| 05 | — | 20182100 | — | WI |
| 01 | — | 547140 | DEAN CARE | WI |