| NPI | 1063590214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE JOHNSON Co President And CEO 612-287-1619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MN 10033342cdt) |
| Additional Taxonomies | 101Y00000X Counselor |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-08-18 |