1003944620 NPI number — CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD

Table of content: (NPI 1003944620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003944620 NPI number — CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC CHARITIES OF THE DIOCESE OF ST. CLOUD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOPE - WAIVERED
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003944620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2390
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56302-2390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-650-1550
Provider Business Mailing Address Fax Number:
320-650-1510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 ROOSEVELT RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56301-5478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-240-3324
Provider Business Practice Location Address Fax Number:
320-240-3339
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DILLMAN
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
320-650-1545

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 936315701 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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