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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