National Provider Identifier Database

BLACK RIVER MEMORIAL HOSPITAL INC
Hospice Care, Community Based


Contact Information

BLACK RIVER MEMORIAL HOSPITAL INC
311 COUNTY ROAD A STE 1
BLACK RIVER FALLS, WI54615-8205
Phone: 715-284-5361
Fax: 715-284-1390
Website:
Specialty Taxonomy Code
* Hospice Care, Community Based 251G00000X

* Indicates primary specialty

NPI Profile & details for BLACK RIVER MEMORIAL HOSPITAL INC

NPI Number 1063516078
Legal business name
LBN
BLACK RIVER MEMORIAL HOSPITAL INC
Authorized official MARY BETH WHITE-JACOBS - (PRESIDENT & CEO)
Entity Organization
Organization subpart No
Enumeration date 09/11/2006
Last updated 12/16/2016 - About 9 years ago
Sole proprietor1 Not specified
Identifiers
  • WI License #: 1037
  • WI Medicaid: 43189700

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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