| NPI | 1013282946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK GORDON RODNING Owner 612-636-0136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 00010) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MN 5459) |
| Enumeration Date | 2012-03-10 |
| Last Update Date | 2012-03-10 |