AGNESIAN HEALTHCARE, INC (NPI# 1598743726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598743726 |
| Entity Type | Organization |
| Organization Name | AGNESIAN HEALTHCARE, INC |
| Other Organization Name | ST AGNES HOSPITAL BEHAVIORAL HEALTH |
| Practice Address |
430 E Division St Fond Du Lac WI 54935-4560 |
| Practice Telephone | 9209292300 |
| Practice Fax Number | 9209268885 |
| Mailing Telephone | 9209292300 |
| Mailing Fax Number | 9209268885 |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2017-05-02 |
| Authorized Official Name | BONNIE R SCHMITZ (CFO) |
| Authorized Official Telephone | 9209264480 |
| Is Organization Subpart | Y |
| Parent Organization Name | AGNESIAN HEALTHCARE, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273R00000X | Psychiatric Unit | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 11013000 | 05 | |
| WI | DEAN CARE | 547140 | 01 |
| WI | VESTICA | 101159 | 01 |
| Other Name | Type Code |
|---|---|
| ST AGNES HOSPITAL BEHAVIORAL HEALTH | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942274717 | Agnesian Healthcare, Inc | Hospice Care, Community Based | 239 Trowbridge Dr, Fond Du Lac, WI 54937-9180 | 2006-02-16 |
| 1861467144 | Agnesian Healthcare, Inc | Home Health | 239 Trowbridge Dr, Fond Du Lac, WI 54937-9180 | 2006-02-21 |
| 1114992492 | Agnesian Healthcare, Inc | Home Infusion | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2006-02-21 |
| 1538147749 | Agnesian Healthcare, Inc | Rehabilitation Unit | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2006-01-06 |
| 1346228541 | Agnesian Healthcare, Inc | General Acute Care Hospital | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2006-01-06 |
| 1578541785 | Agnesian Healthcare, Inc | Skilled Nursing Facility | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2006-01-06 |
| Street Address |
430 E DIVISION ST |
| City | FOND DU LAC |
| State | WI |
| Zip Code | 54935-4560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437157831 | Gilberto Cantu | Nurse Anesthetist, Certified Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2005-07-09 |
| 1992306310 | Leah Timm | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-11-03 |
| 1982212312 | Tiffany M Parker | Counselor | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-07-22 |
| 1619594355 | Brynn Sytsma | Student in an Organized Health Care Education/Training Program | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-06-29 |
| 1891312633 | Joshua Mckinney | Counselor | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-06-27 |
| 1275153264 | Jacalyn Lucille Wendt Coleman | Dietitian, Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-04-20 |
| 1568090884 | Jaclyn R Monteverde | Physician Assistant | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-31 |
| 1235766718 | Emily Jean Thiel | Dietitian, Registered | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-25 |
| 1326674136 | Alexandria Lynn Hefter | Nurse Practitioner | 430 E Division St, Fond Du Lac, WI 54935-4560 | 2020-03-13 |
| 1952933046 | Gina Paveglio | Registered Nurse | 430 E Division St, Surgery Dept, Fond Du Lac, WI 54935 | 2020-02-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609482249 | Keziah Sherri Love | Counselor | W390 Wi-23, Fond Du Lac, WI 54935 | 2020-09-18 |
| 1891341988 | Cynthia Louise Singleton | Nurse Practitioner | 16 E 13th St., Fond Du Lac, WI 54935 | 2019-08-14 |
| 1083183297 | Elena Alexandra Giese | Nurse Practitioner | 430 E. Division St, Fond Du Lac, WI 54935 | 2018-11-16 |
| 1669963740 | Elizabeth Anne Machi | Student in an Organized Health Care Education/Training Program | 885 Western Ave Ste 300, Fond Du Lac, WI 54935 | 2018-05-23 |
| 1184150021 | Jordan Moehn | Specialist/Technologist | 633 Prairie Pkwy, Fond Du Lac, WI 54935 | 2017-05-11 |
| 1467856336 | Chuentao Ho | Specialist/Technologist | 45 South National Ave., Fond Du Lac, WI 54935 | 2014-10-21 |
| 1437587961 | Paula Seeley | Nurse Practitioner | 63 West Pioneer Rd, Fond Du Lac, WI 54935 | 2013-10-18 |
| 1144516030 | Bonnie Kay Mallon | Registered Nurse | 118 E 9th St, Fond Du Lac, WI 54935 | 2011-06-20 |
| 1770885600 | Holly Shepard | Counselor | 23 W Scott St., Fond Du Lac, WI 54935 | 2010-11-29 |
| 1437479110 | Ruth Marie Bohn | Occupational Therapy Assistant | 244 North Macy Street, Fond Du Lac, WI 54935 | 2010-06-04 |
| Find all providers in zip 54935 | ||||
| Taxonomy Code | 273R00000X |
| Grouping | Hospital Units |
| Classification | Psychiatric Unit |
| In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning. |
| Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27. |
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|---|---|---|---|---|
| 1003182346 | James Arthur Hennes | Psychiatric Unit | 515 Veterans St., Tomah, WI 54660 | 2012-03-30 |
| 1417170283 | Aurora Health Care Metro, Inc. | Psychiatric Unit | 2900 W Oklahoma Ave., Milwaukee, WI 53215 | 2007-04-10 |
| 1811926132 | Columbia St. Mary's Hospital Milwaukee, Inc | Psychiatric Unit | 2323 N Lake Drive, Milwaukee, WI 53211-4508 | 2006-06-30 |
| 1437105624 | Community Memorial Hospital of Menomonee Falls Inc | Psychiatric Unit | W180 N 8085 Town Hall Rd, Menomonee Falls, WI 53052 | 2006-05-26 |
| 1740747559 | Columbia St Mary's Hospital Ozaukee, Inc. | Psychiatric Unit | 13111 N Port Washington Rd, Mequon, WI 53097-2416 | 2019-02-28 |
| 1093205163 | Ascension Ne Wisconsin, Inc | Psychiatric Unit | 500 S Oakwood Rd, Oshkosh, WI 54904 | 2018-05-15 |
| 1528560018 | Watertown Medical Center LLC | Psychiatric Unit | 125 Hospital Drive, Watertown, WI 53098 | 2018-03-01 |
| 1982901542 | Milwaukee County Mental Health Division | Psychiatric Unit | 9201 W Watertown Plank Rd, Milwaukee, WI 53226-3558 | 2011-02-17 |
| 1629221502 | Mohammad Mallick, Md, LLC | Psychiatric Unit | 1525 Liberty Ct, Brookfield, WI 53045-5327 | 2008-10-23 |
| 1184800468 | St. Josephs Community Hospital of West Bend Inc. | Psychiatric Unit | 3200 Pleasant Valley Rd, West Bend, WI 53095-9274 | 2008-01-16 |
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| City | FOND DU LAC |
| Zip Code | 54935 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.