Healthcare Provider Details

I. General information

NPI: 1801093869
Provider Name (Legal Business Name): OLMSTED COUNTY COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 3RD AVE SE
ROCHESTER MN
55904-7947
US

IV. Provider business mailing address

1421 3RD AVE SE
ROCHESTER MN
55904-7947
US

V. Phone/Fax

Practice location:
  • Phone: 507-287-1564
  • Fax: 507-529-4132
Mailing address:
  • Phone: 507-287-1564
  • Fax: 507-529-4132

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: MR. PATRICK BRENDLE MCEVOY
Title or Position: MANAGER
Credential: MSW
Phone: 507-287-1564