| NPI | 1003639113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ITANG WANG CEO 507-923-7858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2024-11-15 |