Organization
AGNESIAN HEALTHCARE INC
Active
Other names
SSM Health Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH R MINERATH (SYSTEM DIRECTOR - GOV'T REIMB.)
(608) 445-2411
Entity
Organization
Contact information
Practice address
40 CAMELOT DR, FOND DU LAC, WI 54935-8049
(920) 907-8201
(920) 907-8209
Mailing address
40 CAMELOT DR, FOND DU LAC, WI 54935-8049
(920) 907-8201
(920) 907-8209
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391995430017
BCBS GROUP NUMBER
WI
Enumeration date
03/07/2007
Last updated
01/21/2025
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