| NPI | 1003951989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA JEAN GRAMS Owner 651-645-6100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 8309612 CDT) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2019-06-12 |