Provider Demographics
NPI:1669418851
Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-ROCHESTER
Entity type:Organization
Organization Name:COMMUNITY BEHAVIORAL HEALTH HOSPITAL-ROCHESTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMMERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-431-3693
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:651-431-7505
Practice Address - Street 1:251 WOODLAKE DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5530
Practice Address - Country:US
Practice Address - Phone:507-205-2561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN693127000Medicaid
MN693127000Medicaid