Provider Demographics
NPI:1093876732
Name:LEO A. HOFFMANN CENTER, INC.
Entity Type:Organization
Organization Name:LEO A. HOFFMANN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:507-934-6122
Mailing Address - Street 1:1715 SHEPPARD DRIVE
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:ST. PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-0060
Mailing Address - Country:US
Mailing Address - Phone:507-934-6122
Mailing Address - Fax:507-934-2594
Practice Address - Street 1:1715 SHEPPARD DRIVE
Practice Address - Street 2:
Practice Address - City:ST. PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-0060
Practice Address - Country:US
Practice Address - Phone:507-934-6122
Practice Address - Fax:507-934-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801377322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children