| NPI | 1043005366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IDIL A FARAH Clinical Director 612-816-5623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-10-01 |