| NPI | 1063641793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE M JOHNSON President 612-205-7989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1872) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2009-07-02 |