Healthcare Provider Details

I. General information

NPI: 1508804683
Provider Name (Legal Business Name): ST. PETER REGIONAL TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FREEMAN DR
SAINT PETER MN
56082-3504
US

IV. Provider business mailing address

PO BOX 64979
SAINT PAUL MN
55164-0979
US

V. Phone/Fax

Practice location:
  • Phone: 507-931-7100
  • Fax:
Mailing address:
  • Phone: 651-431-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number331068
License Number StateMN

VIII. Authorized Official

Name: ROD L KORNRUMPF
Title or Position: MENTAL HEALTH ADMIN OFFICER
Credential:
Phone: 763-712-4010