| NPI | 1043072234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAMS MOHAMED ALI CEO 612-486-2134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2025-03-05 |