| NPI | 1043219728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WES VAN ESSEN Administrator 507-777-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 801702-3-CDT) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 1033814-1-DS) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2020-08-22 |