Provider Demographics
NPI:1285687624
Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-ST PETER
Entity Type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-ST PETER
Other - Org Name:CBHH-ST PETER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADULT MENTAL HEALTH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORNRUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:851-431-5003
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:651-431-3692
Mailing Address - Fax:
Practice Address - Street 1:2000 KLEIN ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-5800
Practice Address - Country:US
Practice Address - Phone:507-931-5001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
244010Medicare Oscar/Certification