MEDICARE: CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332U00000X	Home Delivered Meals

General Provider Information

NPI Number	:	1043348535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD

Provider Business Mailing Address
First Line	:	PO BOX 2390
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56302-2390
Country	:	US
Telephone Number	:	320-650-1550
Fax Number	:	320-650-1528

Provider Business Practice Location Address
First Line	:	157 ROOSEVELT RD
Second Line	:	SUITE 200
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-5478
Country	:	US
Telephone Number	:	320-229-4588
Fax Number	:	320-253-7464

Authorized Official
Title or Position	:	FINANCIAL DIRECTOR
Name	:	JOANNE BROSCHOFSKY
Credential	:
Telephone Number	:	320-650-1571

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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