| Organization Name: | BRAINERD STATE HOSPITAL |
| NPI Number: | 1093752594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROD L KORNRUMPF (MENTAL HEALTH ADMIN OFFICER) |
| Mailing Address: | 11800 State Highway 18 Brainerd |
| State: | MN US |
| Postal Code: | 564016250 |
| Phone Number: | 2188282201 |
| Fax Number: | |
| NPI Enumeration Date: | 06/01/2006 |
| NPI Last Update Date: | 11/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 283Q00000X |
| License Number: | 331059 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Psychiatric Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |