Healthcare Provider Details

I. General information

NPI: 1073543344
Provider Name (Legal Business Name): RHSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 SHERBURNE AVE
SAINT PAUL MN
55104
US

IV. Provider business mailing address

NW 3969 PO BOX 1450
MINNEAPOLIS MN
55485-3969
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-4370
  • Fax: 651-254-3541
Mailing address:
  • Phone: 651-254-4301
  • Fax: 651-254-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateMN

VIII. Authorized Official

Name: CYNTHIA PETERSON
Title or Position: DIRECTOR
Credential:
Phone: 651-254-9350