Healthcare Provider Details

I. General information

NPI: 1982819561
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF THE DIOCESE OF ST CLOUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 7TH AVE S
SAINT CLOUD MN
56301-5711
US

IV. Provider business mailing address

PO BOX 2390
SAINT CLOUD MN
56302-2390
US

V. Phone/Fax

Practice location:
  • Phone: 320-650-1500
  • Fax: 320-650-1508
Mailing address:
  • Phone: 320-650-1660
  • Fax: 320-650-1528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNE BROSCHOFSKY
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 320-650-1571