Healthcare Provider Details

I. General information

NPI: 1972650893
Provider Name (Legal Business Name): GERARD TREATMENT PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
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

1111 28TH ST NE
AUSTIN MN
55912-6410
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number831080-5-CRF
License Number StateMN

VIII. Authorized Official

Name: MR. LOREN CARL NERISON
Title or Position: ADMISSIONS COORDINATOR
Credential:
Phone: 507-434-4433