Provider Demographics
NPI:1750631115
Name:GERARD TREATMENT PROGRAMS, LLC
Entity Type:Organization
Organization Name:GERARD TREATMENT PROGRAMS, LLC
Other - Org Name:GERARD ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-433-1843
Mailing Address - Street 1:PO BOX 715
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-0715
Mailing Address - Country:US
Mailing Address - Phone:507-433-1843
Mailing Address - Fax:507-433-7868
Practice Address - Street 1:1111 28TH ST NE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-6410
Practice Address - Country:US
Practice Address - Phone:507-433-1843
Practice Address - Fax:507-433-7868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERARD TREATMENT PROGRAMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972650893OtherNPI FOR RESIDENTIAL TREATMENT