Healthcare Provider Details

I. General information

NPI: 1750631115
Provider Name (Legal Business Name): GERARD TREATMENT PROGRAMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 28TH ST NE
AUSTIN MN
55912-6410
US

IV. Provider business mailing address

PO BOX 715
AUSTIN MN
55912-0715
US

V. Phone/Fax

Practice location:
  • Phone: 507-433-1843
  • Fax: 507-433-7868
Mailing address:
  • Phone: 507-433-1843
  • Fax: 507-433-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENTON E HENRY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 507-433-1843