| NPI | 1013311802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SHAGALOW Owner 612-998-5669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 1074289) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |