Provider Demographics
NPI:1487378956
Name:STCH DE PERE WI OPCO LLC
Entity type:Organization
Organization Name:STCH DE PERE WI OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARTNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-735-3656
Mailing Address - Street 1:7755 3RD ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5461
Mailing Address - Country:US
Mailing Address - Phone:651-237-9716
Mailing Address - Fax:
Practice Address - Street 1:420 S WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4217
Practice Address - Country:US
Practice Address - Phone:920-305-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based