| NPI | 1063299337 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN PAUL DIEFFENBACH Chief Manager 651-338-9435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-11-13 |