| Organization Name: | BLACK RIVER MEMORIAL HOSPITAL INC. |
| NPI Number: | 1003914011 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY BETH WHITE-JACOBS (PRESIDENT & CEO) |
| Mailing Address: | 711 W Adams St Black River Falls |
| State: | WI US |
| Postal Code: | 546159108 |
| Phone Number: | 7152845361 |
| Fax Number: | 7152841390 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 07/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 275N00000X |
| License Number: | 1037 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Hospital Units |
| Taxonomy Classification: | Medicare Defined Swing Bed Unit |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit. |