Healthcare Provider Details

I. General information

NPI: 1720356439
Provider Name (Legal Business Name): OLMSTED COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 CAMPUS DR SE
ROCHESTER MN
55904-4800
US

IV. Provider business mailing address

2117 CAMPUS DR. SE STE 200
ROCHESTER MN
55904
US

V. Phone/Fax

Practice location:
  • Phone: 507-328-6400
  • Fax: 507-328-6263
Mailing address:
  • Phone: 507-328-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11982
License Number StateMN

VIII. Authorized Official

Name: SUZANN MARIE BAKKEN
Title or Position: ASSISTANT CONTROLLER
Credential:
Phone: 507-328-6460