Provider Demographics
NPI:1164627022
Name:SOUTH CENTRAL CRISIS CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL CRISIS CENTER
Other - Org Name:ST. PETER REGIONAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH ADMIN OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORNRUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-712-4010
Mailing Address - Street 1:PO BOX 64979
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55164-0979
Mailing Address - Country:US
Mailing Address - Phone:651-431-3676
Mailing Address - Fax:
Practice Address - Street 1:521 PFAU ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7032
Practice Address - Country:US
Practice Address - Phone:507-389-6872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETER REGIONAL TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN647618100Medicaid
MN467058206Medicaid