Healthcare Provider Details

I. General information

NPI: 1093876732
Provider Name (Legal Business Name): LEO A. HOFFMANN CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 SHEPPARD DRIVE
ST. PETER MN
56082-0060
US

IV. Provider business mailing address

1715 SHEPPARD DRIVE PO BOX 60
ST. PETER MN
56082-0060
US

V. Phone/Fax

Practice location:
  • Phone: 507-934-6122
  • Fax: 507-934-2594
Mailing address:
  • Phone: 507-934-6122
  • Fax: 507-934-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number801377
License Number StateMN

VIII. Authorized Official

Name: MR. GENE FRANKLIN TAYLOR
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LPC
Phone: 507-934-6122