Provider Demographics
NPI:1982819561
Name:CATHOLIC CHARITIES OF THE DIOCESE OF ST CLOUD
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF ST CLOUD
Other - Org Name:HEALTH SERVICES PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSCHOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-650-1571
Mailing Address - Street 1:PO BOX 2390
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56302-2390
Mailing Address - Country:US
Mailing Address - Phone:320-650-1660
Mailing Address - Fax:320-650-1528
Practice Address - Street 1:1726 7TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-5711
Practice Address - Country:US
Practice Address - Phone:320-650-1500
Practice Address - Fax:320-650-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service