Provider Demographics
NPI:1912013848
Name:SOUTH CENTRAL HUMAN RELATIONS CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL HUMAN RELATIONS CENTER
Other - Org Name:SAFE HARBOUR
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:507-451-2630
Mailing Address - Street 1:610 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4704
Mailing Address - Country:US
Mailing Address - Phone:507-451-2630
Mailing Address - Fax:507-455-8133
Practice Address - Street 1:185 LANDMARK DR.
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-5702
Practice Address - Country:US
Practice Address - Phone:507-455-8100
Practice Address - Fax:507-446-8056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL HUMAN RELATIONS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN403151200Medicaid