| NPI | 1023225430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL BRADSETH Authorized Manager 218-407-2425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 714818600) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-09-13 |