| NPI | 1043465321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG LYLE POLSFUSS CEO 952-922-9056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP0620) |
| Enumeration Date | 2008-11-30 |
| Last Update Date | 2008-11-30 |